...to verify procedures and payment mechanisms are compliant. Our proactive monitoring includes prepay review edits, prior authorization monitoring, analytic performance dashboard monitoring, and verification of services. Our reactive monitoring includes...

...Use the HL7 FHIR (Fast Healthcare Interoperability Resource) for patient and publicly available provider data Use of OAuth 2.0 or Open ID for authorization flows to support for member authorization...

...role of CANS in determining OhioRISE eligibility. This flier can be distributed by CANS assessors prior to or at the time of a CANS assessment. Care Coordination Portal Access Training...

We make it easy for you to request services for your patients. See below for benefit information and instructions to obtain services that enable improved access to care. 9-8-8 Suicide...

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...

...exam, cleaning, fluoride treatments and dental implants. *Prior Authorization required. Vision Benefits No cost routine eye exam. Routine Exam, Eyeglasses are covered: Age 21-59 – 1 pair every 2 years;...

Provider Attestation Form – Submit this form to attest to practice competency prior to working with CareSource. CCVS Provider Authorization and Release Form – Submit this form to authorize release...

We are excited to welcome you as a CareSource member and introduce some of the programs and tools that make CareSource more than just health insurance. We are Health Care...

...you know we got your appeal. The people making appeal decisions are not part of prior reviews or decision making. They are health care professionals. They are supervised by our...

At TrueCare, we are more than just quality health insurance. We care about YOU. We know that life can be hectic. Making your health and wellness a priority can be...