...Hospital Interim Billing Inpatient Prior Authorization/Precertification Independent Provider Q&A Delivery and Gestation Diagnosis Codes ICD-10 Resource Center ICD-10 Health Partner Readiness Webinar Slides Network Notifications Frequently Asked Questions Centers for...

...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...

...will not pay for claims for dates of service prior to the credentialing approval date. Contracting Upon a provider’s interest in contracting with CareSource, the process below is followed: CareSource...

...need prior approval Member Responsibilities As a member of our health plan you must also be sure to: Review your HAP CareSource member materials Make and keep appointments with your...

...is important to verify beneficiary eligibility using their Beneficiary ID card and our provider portal prior to each service rendered. We recommend that you check member eligibility each and every...

...Health Equity Accreditation provides an actionable framework for helping health systems continuously improve—and prioritize—health equity for the members and communities we serve. NCQA LONG-TERM SERVICES AND SUPPORTS (LTSS) DESTINCTION Michigan...

...And so much more! *Some services need to be approved before you can get them. This is called prior authorization (pre-authorization). It must be medically necessary for your care. Your...

...operational and membership targets, improving customer satisfaction ratings, and enhancing quality and HEDIS results. Prior to joining CareSource in 2016, Mike held a number of executive roles for other health...

...We prioritize people over profits, channeling resources back into members, providers, communities, and employees. For more information, take a look at our Partner with Purpose contracting brochure. This resource reviews...

...professionals and facilities The billing and payment of your claims The review of your health care and use of benefits The prior authorization of your requested services Data exchanged for...