...for D-SNP members based on their unique needs. The overarching QI program goals are aligned with the Institute for Healthcare Improvement Quadruple aim of: Improving health outcomes of members and...

...their care can effectively coordinate their care We recommend that you check member eligibility each time a member presents for services, as member eligibility can fluctuate. Changes in health status...

...member use. All CareSource® members choose or are assigned a primary care provider (PCP) upon enrollment in the plan. PCPs should help facilitate a medical home for members. This means...

...and/or the denied claim If filing an appeal on behalf of a member or for pre-service issues, the member’s written consent (or signed Appointment of Representative form(coming soon) for dual...

...response to Formulary drugs. The member or member’s representative can call Member Services to make the request or can complete the online Member Exception Request for Non-Formulary Medication. When a...

...detail will be denied. Error Number: 30 Error Description: Member mismatch How to Fix: Either the member had the wrong sex identified on the claim submission, or the member’s address...

...member. Get a CareSource member ID Card, Plan Documents or Change Your Doctor How do I get a new CareSource member ID card? Log into your My CareSource account to...

...the member’s card? Yes! Any participating primary care provider (PCP) may see eligible CareSource members. PCPs are responsible for verifying member eligibility before providing any services. Please log on to...

...Member Services Members access Member Services by calling our toll-free number, 1-855-202-0729 (TTY for the hearing impaired: 1-800-255-0056), 7 a.m. – 7 p.m. Eastern Standard Time (EST), and following the...

...members with culturally and linguistically diverse needs Ensuring that CareSource is effectively serving members with complex health needs Assessing the characteristics and needs of the member population Assessing the geographic...