mih Let us know if you are unhappy or do not agree with a decision made by us or our providers. We want to make it right. Please call Member...

...part of prior reviews or decisions. Please call Member Services if you are not happy with our decision. You also have the right to file a complaint at any time...

...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...

...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...

...You should get urgent care from the nearest and most appropriate health care provider. Emergency care is covered both in and out of our service area. Prior to seeking urgent...

...best-in-class achievements to support CareSource’s mission of growth. Prior to joining CareSource, Larry was recently the Senior Vice President and Chief Actuary for WellCare, where he led the actuarial and...

...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 Medicaid Michigan Medicare...

...Prior Authorization Provider Communications CareSource PASSE supports coordination across all interventions along the continuum of care. Visit these pages for resources to support coordinated care with a holistic, integrated approach:...

...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...