At CareSource, we streamline our business practices to limit the administrative burden on you and our members. Our goal is to make it easier for you to help our members...

...tobacco during pregnancy can cause many problems for your baby, such as: Miscarriage or stillbirth. Premature birth. Low birth weight. Sudden Infant Death Syndrome (SIDS). Asthma and other breathing problems....

...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...

...Program Medical Centralized Administrative Responsibilities To reduce provider burden and promote consistency, ODM has retained administrative responsibilities for the following: Centralized Claims Submissions: OMES acts as a single clearinghouse for...

...review determinations are based only on appropriateness of care and service and existence of coverage. CareSource does not reward health care partners or our own staff for denying coverage or...

...and the treating provider may not proceed with that service or supply after receiving a denial from CareSource for the requested non-covered service. Existing clinical policies are regularly reviewed and...

These reimbursement policies apply to the TRICARE Prime® Demo by CareSource Military & Veterans™ plan. Reimbursement policies are designed to assist you when submitting claims to us. They are routinely...

...adjusted, if it’s denied? If you receive notification of a claim denial, you should follow the steps based on the reason for denial (coming soon). Questions? ODM is working with...

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...