Appeals Non-participating providers may request reconsideration of a claim denial. You must request an appeal within 60 days of the date of the remittance advice, and a signed Waiver of...

...final adverse determination notice) for clinical denials by contacting CareSource and for coverage denials by contacting the Kentucky Department of Insurance. You must ask for an external review within 120...

All CareSource members choose or are assigned to a primary care provider (PCP) when they enroll in the plan. They can change to another network PCP as often as needed....

...Providers may not charge members for services which CareSource PASSE™ denied based on lack of medical necessity or lack of compliance to contractual terms. Providers may not bill members for...

To have your health care services covered by your CareSource plan, you must get them from a network provider. The only exceptions are: In cases of emergency; If you need...

...Dental Services Routine dental checkups and dental cleanings are covered under Hoosier Healthwise, HIP Plus, HIP State Plus, and HIP State Basic and HIP Maternity plans. You can find a...

Our Quality Improvement (QI) Program is designed to ensure the organization delivers on all aspects of care delivery for beneficiaries based on their unique needs. We monitor, analyze and identify...

...delivered directly to you at no extra cost for many prescriptions. Dental Dental $4,000 annual allowance for preventative services such as oral exams and cleanings as well as services like...

...HIV/AIDS. Tobacco, in all forms, also causes many other health issues. These issues can be: Heart disease. Cancer Breathing problems. Dental problems. Eye and ear problems. Bone problems. Reproductive problems....

...your OB provider about? Check out this guide for vaccinations during pregnancy. Go to routine dental visits During pregnancy, keeping your teeth and gums healthy can become a challenge. This...