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Medication Therapy Management
https://www.caresource.com/members/tools-resources/find-my-prescriptions/medication-therapy-management/...Medication List and Medication Action Plan by mail. Quarterly targeted medication reviews. Follow-up steps as necessary. Who Can Be in the Program? CareSource members who have chronic health conditions and...
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Find A Pharmacy
https://www.caresource.com/members/tools-resources/find-my-prescriptions/find-a-pharmacy/...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...
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Patient Care
https://www.caresource.com/providers/education/patient-care/...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...
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Member Overview
https://www.caresource.com/members/...(Medicare-Medicaid Plan) is a health plan that contracts with both Medicare and Michigan Medicaid to provide benefits of both programs to enrollees. CareSource, Inc. is a not-for-profit, 501(c)(3) entity. Its...
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Medical Policies
https://www.caresource.com/providers/tools-resources/health-partner-policies/medical-policies/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...
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Reimbursement Policies
https://www.caresource.com/providers/tools-resources/health-partner-policies/reimbursement-policies/...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...
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How and When to File an Appeal
https://www.caresource.com/members/tools-resources/grievance-appeal/file-appeal/...Benefit Determination A decision we make about your coverage or benefits is called a benefit determination. If you believe a decision we have made adversely affects you, you have a...
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Preferred Drug List
https://www.caresource.com/plans/medicaid/benefits-services/pharmacy/preferred-drug-list/...Lists Georgia Medicaid and PeachCare for Kids® Planning for Healthy Babies® (P4HB) Family Planning P4HB Inter-Pregnancy Care (IPC) Over-The-Counter (OTC) Product List Find My Prescriptions Do you want to look...
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Preventive Care
https://www.caresource.com/members/education/preventive-care/...strength of your bones. If you are between 50 and 65, talk with your provider to see if you need a bone density test. Breast Cancer Screen: Women between the...
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Health and Social Partnerships
https://www.caresource.com/providers/education/health-equity/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...
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