Stay Informed and Explore New Ways to Work with Us CareSource® publishes newsletters so you can stay informed about plan news and explore new ways to work with us to...

...pages may not be inclusive of all applicable provider policies. Some benefit management services are provided on behalf of CareSource. Please reference applicable lab policies and musculoskeletal and cardiac surgical...

...first before CareSource will cover it. This is called Step Therapy. Some medicines require permission (prior authorization) in order for it to be covered by your plan. The health partner...

...our members: Behavioral Health Find behavioral health resources for patients with mental health, substance use and co-occurring medical issues. Behavioral Health Carve-In Get support during the transition to Behavioral Health...

...illnesses, but COVID-19 is caused by a different virus than the flu. COVID-19 is caused by the SARS-COV-2 virus and flu is caused by the Influenza A and Influenza B...

...may be subject to limitations and/or qualifications. Payment will be determined based upon a review of the actual services provided to a member and will be determined when the claim...

These medical policies apply to the CareSource plan. Medical policies offer guidance on determination of medical necessity and appropriateness of care for approved benefits. Benefit determinations and coverage decisions are...

...receiving the Adverse Benefit Determination. Appeals can be submitted by phone, in writing or by fax or email. All internal appeal requests must have: The covered person’s name and ID...

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...

...the PDL, they are posted below each quarter. Preferred Drug Lists Georgia Medicaid and PeachCare for Kids® Planning for Healthy Babies® (P4HB) Family Planning P4HB Inter-Pregnancy Care (IPC) Over-The-Counter (OTC)...