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Claim Payment Disputes
https://www.caresource.com/providers/provider-portal/claim-payment-disputes/...requests will be returned with no action taken. Payments disputes can be submitted to CareSource through the following methods: Provider Portal: https://providerportal.caresource.com Provider Portal Provider Portal: https://providerportal.caresource.com Provider Portal: https://providerportal.caresource.com...
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Reimbursement Policies
https://www.caresource.com/providers/tools-resources/health-partner-policies/reimbursement-policies/...determined based upon a review of the actual services provided to a beneficiary and will be determined when the claim is received for processing. Providers and their office staff are...
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Benefits and Services
https://www.caresource.com/plans/marketplace/benefits-services/...Update For 2025, CareSource Marketplace Plans feature the following benefits: TruHearing® provider network for hearing services is included with all plans. EyeMed® provider network for vision services on all plans...
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Vision
https://www.caresource.com/providers/education/patient-care/vision/...vision services for our beneficiaries. Our vision providers can access the following tools to help them provide efficient and quality care: Provider Portal Register for the Provider Portal to access...
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Tools & Resources
https://www.caresource.com/members/tools-resources/...don’t agree with a decision made by us or our providers, let us know. Get Started Reporting Fraud, Waste & Abuse Reporting Fraud, Waste & Abuse Report a provider, pharmacy...
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Substance Use Disorder
https://www.caresource.com/members/education/mental-health/addiction-help/...disease from needle sharing. Find a needle exchange program near you. Go to https://nasen.org/directory. Find a Provider Use our Find a Doctor tool to find providers like family therapists, social...
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Staying Safe From Infections
https://www.caresource.com/members/education/preventive-care/staying-safe-from-infections/...a Doctor/Provider Tool Looking for a primary care provider (PCP)? If so, you can find one with ease using our Find a Doctor/Provider tool. Find a PCP Today Vaccination Sites...
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Drug Formulary Changes
https://www.caresource.com/providers/tools-resources/drug-formulary/drug-formulary-changes/...June 1, 2023 05/01/2023 Provider Summary of PDL Changes Effective April 1, 2023 03/01/2023 Provider Summary of PDL Changes Effective January 1, 2023 12/01/2022 Provider Summary of PDL Changes Effective...
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Next Generation Managed Care
https://www.caresource.com/providers/tools-resources/next-generation-managed-care/...the Ohio Revised Code. Sample Network Provider Agreement We have provided sample copies of our provider agreement and addendum. Provider Agreement – View the Provider Agreement Appendix C – Ohio...
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Behavioral Health Carve-In
https://www.caresource.com/providers/education/patient-care/behavioral-health-carve-in/...enrolled as a provider type 95 (community substance use disorder program) with provider specialty 950 AND either licensed by OhioMHAS as a methadone treatment administration program (provider specialty 951) AND/OR...
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