...as tools to coordinate the best possible integrated care: Addiction Help Care Coordination Clinical Care Guidelines Depression Screenings Find a Doctor Forms Interpreter Services Opioid Tool Kit Pregnancy Preventive Health...

...is the best care for your needs. The UM department performs activities such as: prior authorization (PA), pre-service review, expedited review, post-service review, discharge planning and other utilization activities. If...

...vendors for goods or services Preventing members from accessing covered services resulting in underutilization of services offered Altering/destroying member materials, medical records, etc. Backdating forms The Federal False Claims Act:...

...for strategic and regulatory leadership. Rogers began her career in occupational therapy and successfully operated a multi-location therapy practice in central Mississippi. Her clinical background informs her commitment to strengthening...

Why Join the TRICARE Prime® Demo by CareSource Military & Veterans™ Health Network TRICARE Prime Demo transforms health care for the military community through care coordination and integrated programs that...

The frequently asked questions below are intended to help First Tier, Downstream and Related Entities (FDR) understand and manage their compliance efforts. Please click on the expandable menus below to...

Our Program Integrity Department handles cases of managed care fraud, waste or abuse. It can be done by providers, pharmacies, or members. Fraud means the purposeful misuse of or for...

...program, there are no additional forms to fill out. You can learn more about CareSource reward programs, including all rewardable activities, on a helpful Rewards for Wellness infographic. Learn more...

Get Your Prescriptions Delivered to Your Door! You can get many of your Medicare Part D drugs sent to your home through mail. We work with Express Scripts® to offer...

...agent, has implemented a Credentialing Verification Organization (CVO) which performs credentialing and recredentialing functions for providers enrolled or seeking to enroll in the Georgia Families® network. CareSource® will include in...