Our Provider Manual is a resource for working with our health plan. This manual communicates policies and programs and outlines key information, such as claim submission, and reimbursement processes, authorizations,...

...information (SHI). The Member Consent/HIPAA Authorization Form can also be used to designate a person to speak on the member’s behalf. Please encourage CareSource members who have not consented to...

...(prior authorization) in order for it to be covered by your plan. The health partner who orders the drug should help you get a prior authorization. The prior authorization requirements...

...Demo. Utilization Management – View our utilization management activities including prior authorization, concurrent review, discharge planning and other activities. Tobacco and Vaping Cessation Tool Kit – Access our tools and...

...on our Plan Documents page. What is a prior authorization? What services need one? Prior authorization is when your doctor or provider gets approval from CareSource before you can get...

The Public Health Emergency (PHE) for COVID-19 has ended. Services like vaccines, treatment, and testing are still available. Some rules changed, stopped, or started again. CareSource continues to watch COVID-19...

Earn rewards for keeping your patients healthy! Flu shots can keep people healthy and out of the hospital. With so many misconceptions surrounding the flu shot, we need your help...

...needs and taking appropriate action Providing phone coverage for handling patients’ calls 24/7 Following all referral and prior authorization policies and procedures as outlined in the Provider Manual Complying with...

...Forms Find forms for contracting, authorization, claim submission and more. VIEW FORMS Procedure Code Lookup Tool Look up CPT and HCPCS codes to determine if prior authorization is required. Procedure...

...receipt of a pharmacy prior authorization request. If it is an emergency, a 72-hour override may be used so that you can get your medicine. Prior authorization requests for a...