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Access & Availability Standards
https://www.caresource.com/providers/provider-portal/access-availability-standards/...evaluates the quality of health care that health plans provide to their members and how well a health plan manages all parts of its delivery system — physicians, hospitals, other...
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Quality Improvement
https://www.caresource.com/providers/education/quality-improvement/...health outcomes are monitored through routine health plan reporting, annual Healthcare Effectiveness Data and Information Set (HEDIS®). In addition, Marketplace members complete the annual Quality Health Plan (QHP) Enrollee Survey...
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Provider Disputes or Appeals
https://www.caresource.com/providers/provider-portal/appeals/...up to 14 calendar days, if the extension is in the member’s best interest. The plan will make reasonable efforts to provide the member with prompt oral notification of the...
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FAQs
https://www.caresource.com/providers/education/faqs/...a participating health partner? Providers can visit our Plan Participation page to learn how to contract with CareSource. Or, call Health Partner Services at 1-855-202-1058. We can give you the...
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Medicare Prescription Payment Plan
https://www.caresource.com/plans/dsnp/pharmacy/drug-cost-help/mppp/...CareSource? If you disenroll from CareSource or enroll in a new plan with drug coverage, your participation in this payment option will end. You will continue to receive a monthly...
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Care And Disease Management
https://www.caresource.com/providers/education/patient-care/care-management-disease-management/CareSource® offers care coordination that can provide a broad spectrum of educational and follow-up services for your patients. You can access care plans online through the provider portal to easily...
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Fraud, Waste & Abuse
https://www.caresource.com/providers/education/fraud-waste-abuse/...business Corrective action of any identified fraud, waste and/or abuse are available in the provider manual. For provider terminations/suspensions information, see the CareSource Fair Hearing Plan (coming soon). Prohibited Affiliations...
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Quick Reference Materials
https://www.caresource.com/providers/tools-resources/quick-reference-materials/...Carolina Co.® wants to equip you to work with our health plan to provide the best service for our members. These materials will help familiarize you with our Marketplace plans....
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Medicare Prescription Payment Plan
https://www.caresource.com/members/tools-resources/find-my-prescriptions/medicare-prescription-payment-plan/...new plan with drug coverage, your participation in this payment option will end. You will continue to receive a monthly invoice for the amount owed until your balance is paid...
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Pharmacy
https://www.caresource.com/providers/education/patient-care/pharmacy/...covered under a benefit plan. The prior authorization staff will adhere to the CareSource MyCare Ohio Centers for Medicare & Medicaid Services (CMS) approved criteria. The PBM’s National Pharmacy and...
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PLAN PARTICIPATION