Member Rights As a member of CareSource you have the following rights: To get information about CareSource, its services, providers, and member rights and duties. To get all services that...

...nurses through our 24-Hour Nurse Advice Line. No-cost, 24-hour telehealth care providers through Teladoc®. No-cost telehealth mental health and substance use disorder counseling through Teladoc, 7 a.m. to 9 p.m....

...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...

...Abuse Look Like? Health care fraud, waste and abuse can be committed by health providers, members or pharmacies. Examples include the following. Health partners who: Providers who: Order medications, equipment...

...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...

...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...

...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...

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...

...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...

...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...