Our Commitment We are committed to improving our beneficiaries’ health by removing barriers to care and working with our community partners and providers to drive meaningful change. Provider Responsibilities Providers...

...Ohio Medicaid and MyCare Providers: Ohio Medicaid and MyCare providers should utilize the Provider Network Management (PNM) module from the Ohio Department of Medicaid (ODM) for submitting provider applications, credentialing...

...plan will help you reach your goals. It also links your medical health, developmental disability, and specialty health services. Can a care coordinator help pay my utility bills? A care...

...for medical necessity. The retrospective review request must include a copy of the other carrier’s EOP. All requests for services will be reviewed for timeliness and medical necessity. Health partners...

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...

...issues like sinus infections, allergies, rashes, and more. It also gives you quick medical advice. This can help prevent your condition from getting worse. Your providers may offer telehealth. Check...

...by CareSource’s Program Integrity. Examples are listed below. Providers who: Order drugs, equipment or services that are not medically necessary Don’t give medically necessary services due to lower reimbursement rates...

...use network providers to get your medical care and services. The only exceptions are: It is important to know which providers are part of our network. While you are a...

...of providers: Family practice providers: Providers who care for children and adults of all ages and may include obstetrics and minor surgery. Nurse practitioners (NP) and physician assistants (PA):Providers who...

...understand. To work with providers for your health care decisions, including the right to refuse treatment. To get information about any medical care in a way you can understand. To...