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Utilization Management
https://www.caresource.com/plans/mississippi-chip/utilization-management/...company (TrueCare). Staff accept collect calls about UM issues. Staff can answer questions about the UM process. You can call us about: UM for prior authorization (pre-approval) requests Any other...
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Subrogation and Records Request Information
https://www.caresource.com/about-mstc/legal/subrogation-and-records-request-information/...Records For any third-party records requests, please send a letter of representation and compliant HIPAA authorization to: TrueCare Attn: Office of General Counsel 230 N. Main St Dayton, OH 45402...
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In Lieu of Services (ILOS)
https://www.caresource.com/providers/tools-resources/support-services/in-lieu-of-services-ilos/...defined as being unable to obtain nutritionally adequate, medically appropriate and/or safe foods. Submit authorizations within the Provider Portal. For billing, please use the following code: S5170 with V1 Modifier....
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Join Our Network
https://www.caresource.com/providers/join_our_network/At CareSource, we bring true partnership to Georgia providers. As part of our network, you can expect accurate claims processing, efficient prior authorizations and the dedicated commitment of a nonprofit...
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Forms
https://www.caresource.com/plans/tricare-prime-demo/forms/...complaint about a service you received or do not agree with a decision we made. HIPAA Authorization Form: Use this form to share your health information with your providers or...
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Marketplace No Surprises Act Model Notice
https://www.caresource.com/about-us/legal/marketplace-no-surprises-act-model-notice/...plan generally must: Cover emergency services without requiring you to get approval for services in advance (prior authorization) Cover emergency services by out-of-network providers Base what you owe the provider...
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How and When to File an Appeal
https://www.caresource.com/members/tools-resources/grievance-appeal/file-appeal/...of getting the denial letter A state fair hearing ruling is made against you The authorization ends or service limits are met You may request an expedited internal appeal of...
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Rights and Responsibilities
https://www.caresource.com/plans/caresource-passe/plan-documents/rights-responsibilities/...information on PASSE services that are offered by CareSource PASSE that include: Covered benefits and how to get them. If any benefits have prior authorization requirements. Take part in decisions...
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Care And Disease Management
https://www.caresource.com/providers/education/patient-care/care-management-disease-management/...increases access to necessary medications such as MAVYRET for Medicaid beneficiaries by removing the prior authorization requirements and dispensing the medication in an eight-week supply (or a 12-week supply, when...
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Plan Documents
https://www.caresource.com/plans/marketplace/plan-documents/...Benefits-At-A-Glance CareSource insurance plans for individuals and families provide comprehensive benefits including preventive care. Prior authorization is required for certain services. Benefits at a Glance Use this guide to see...
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