Sanjoy Musunuri joined CareSource in 2020 as Executive Vice President, Strategy and Business Development, where he oversees the advancement of new and innovative strategies that create growth opportunities and extend...

...business Corrective action of any identified fraud, waste and/or abuse are available in the provider manual. For provider terminations/suspensions information, see the CareSource Fair Hearing Plan (coming soon). Prohibited Affiliations...

...Department. If you would like to discuss an adverse decision with physician reviewer, please call the Utilization Management department at 1-800-488-0134 within five business days of the determination. Access to...

...adopt our policy on fraud, waste and abuse when handling CareSource business. The Federal False Claims Act Using the False Claims Act (the Act), you can help reduce fraud against...

...disposition of the dispute within 15 business days from the receipt of dispute for claim disputes, and 30 business days for disputes involving medical necessity. Written notice will not be...

...business day. CareSource® strives to make it easy for you to work with us, whether online or over the phone. For questions not addressed on our website, please call Provider...

...has created a custom library of training and resources on topics important to health care providers. Trainings are short (five to seven minutes) to easily fit into your busy schedule....

...Management and Performance Improvement program includes both clinical and non-clinical services and is revised as needed to remain responsive to member needs, provider feedback, standards of care and business needs....

...member benefits, and more to make it easier for you to do business with us. Note: To access, you may need to download Adobe Acrobat Reader. VIEW THE CARESOURCE PASSE...

...discuss the utilization management (UM) medical necessity determination of a denial or decrease in level of care with CareSource’s Medical Director/Behavioral Health Medical Director or designee within five business days...