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Behavioral Health
https://www.caresource.com/providers/education/patient-care/behavioral-health/...access the care they need. Coordinating Integrated Care Coordinated care is key to ensuring optimal outcomes for our members. We ensure our providers have access to behavioral health resources and...
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Quick Start Guide
https://www.caresource.com/members/tools-resources/quick-start-guide/...doctor. All CareSource Marketplace members have access to: No-cost, 24-hour registered nurses through our CareSource24® Nurse Advice Line. No-cost, 24-hour telehealth care providers through Teladoc®. No-cost telehealth mental health and...
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Patient Administration
https://www.caresource.com/providers/education/patient-care/patient-administration/...Providers may not charge members for services which CareSource PASSE™ denied based on lack of medical necessity or lack of compliance to contractual terms. Providers may not bill members for...
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Non-Participating Provider Appeals & Disputes
https://www.caresource.com/providers/provider-portal/appeals/non-participating-provider-appeals-disputes/...non-contracted providers as Medicare would have paid for the same service. Non-contracted providers have the right to request a reconsideration of the plan’s denial of payment: Non-contracted providers have 60...
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Claim Rejection Notifications
https://www.caresource.com/providers/provider-portal/claims/claim-rejection-notifications/...at 1-800-488-0134 or visit https://www.caresource.com/providers/ for instructions. Error Number: 132 Error Description: Missing/Invalid Medicaid ID for Atypical Provider How to Fix: Ensure correct Medicaid ID is provided. Error Number: 187...
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Provider Responsibilities
https://www.caresource.com/providers/education/health-equity/provider-responsibilities/Providers are expected to deliver services in a culturally competent manner, which includes removing all language barriers, accommodating the unique ethnic, cultural and social needs of the member and understand...
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Fraud, Waste & Abuse
https://www.caresource.com/members/tools-resources/fraud-waste-abuse/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...
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Why Choosing a PCP is Important
https://www.caresource.com/members/tools-resources/why-choosing-a-pcp-is-important/...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...
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Dental
https://www.caresource.com/providers/education/patient-care/dental/CareSource’s covered routine dental benefits are administered by Delta Dental. Delta Dental Phone: 1-833-778-7003 Routine Dental Providers Please use the Providers Dental Provider Login menu option of the Provider Portal...
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Quality Improvement Program
https://www.caresource.com/members/tools-resources/quality-improvement/qip/...standards High level of Healthcare Effectiveness Data and Information Set (HEDIS®) performance High level of Consumer Assessment of Healthcare Providers and Systems (CAHPS®) performance Comprehensive population health management program Comprehensive...
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