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Drug Transition Policy
https://www.caresource.com/benefits-services__trashed/pharmacy/drug-transition-policy/...You recently switched plans and your medication is not on your new plan’s covered drug list (formulary). Your plan dropped your medication from its formulary or added coverage restrictions for...
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Additional Services
https://www.caresource.com/plans/medicaid/benefits-services/additional-services/...towards the fee for Boys and Girls Clubs in Georgia is covered. Girl Scouts® : Girl Scout fees are covered in grades K through 8 and adults. Sign up for...
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File a Grievance
https://www.caresource.com/members/tools-resources/grievance-appeal/file-grievance/...treat you fairly. You are not satisfied with the quality of care you received. CareSource denies a service. CareSource gives partial approval to cover a service. CareSource denies payment of...
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Provider Resources
https://www.caresource.com/providers/provider-portal/Claims Claims Submit claims, find processes and access time-saving tools. Submit or Find A Claim Check Eligibility Check Eligibility Verify patient eligibility for coverage and learn more about health statuses....
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It’s Your Birthday Month!
https://www.caresource.com/members/education/diabetes-checkup/...start you on Medical Nutrition Therapy, which is helpful for managing diabetes. Initial and as needed *These services may have some exclusions. For a complete description of covered benefits, please...
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Medical Benefits
https://www.caresource.com/benefits-services__trashed/medical/...our network. Scroll down to Ohio and filter the results under Medicare by selecting Medicare Advantage from the list. Learn more about out-of-network coverage by reviewing your Evidence of Coverage...
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Pharmacy
https://www.caresource.com/plans/mycare-snp/benefits-services/pharmacy/...Medicaid List of Covered Drugs The Medicaid List of Covered Drugs outlines the coverage for certain OTC items and non-Part D drugs included in your plan. This list is what...
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Plan Documents
https://www.caresource.com/plans/mycare-snp/plan-documents/...a coverage determination. Fill out this form: online or hard copy ( English | Spanish). Coverage Redetermination Request Form If you are unhappy with the result of a coverage determination...
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Part C Medical Plan Rights
https://www.caresource.com/members/tools-resources/grievance-appeal/part-c-medical-plan-rights/Organization Determinations (Decisions) A decision we make about the coverage of a service. If you believe you are entitled to a medical service (Part C or Medicaid) you can request...
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Behavioral Health Carve-In
https://www.caresource.com/providers/education/patient-care/behavioral-health-carve-in/...the hospital covered services for behavioral health services. MyCare and Medicaid CBHC (Community BH Centers) Benefit Grid – Use this benefit grid to understand the community behavioral health center covered...
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