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Quality Improvement
https://www.caresource.com/providers/education/quality-improvement/...you would like more information about CareSource PASSE Quality Improvement, please call Provider Services, Monday through Friday, 8 a.m. to 5 p.m. Central Time (CT) at 1-833-230-2100. HEDIS® is a...
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General Plan Information
https://www.caresource.com/plans/marketplace/plan-documents/general-plan-information/...must obtain our prior authorization. When you get emergency care or are treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from balance...
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Provider Disputes or Appeals
https://www.caresource.com/providers/provider-portal/appeals/...right to request a peer-to-peer review, or a member’s right to request an appeal or state hearing, or the timeliness of appeal and/or state hearing resolutions. Clinical Appeals Peer to...
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Archived Reimbursement Policies
https://www.caresource.com/providers/tools-resources/health-partner-policies/reimbursement-policies/archived/...Dental Procedures in Hospital Outpatient Facility or Ambulatory Surgery Center Dental Services Rendered in a Hospital or Ambulatory Surgery Center Drug Testing Drug Testing Drug Testing Drug Testing Drug Testing...
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Where To Get Care
https://www.caresource.com/members/tools-resources/where-to-get-care/...you need to see other doctors (specialists) or admit you to the hospital. However, you are not required to get a referral from your PCP before you see many types...
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Utilization Management
https://www.caresource.com/providers/education/patient-care/utilization-management/...Necessity Criteria CareSource of North Carolina Co. utilizes nationally recognized criteria to determine medical necessity and appropriateness of inpatient hospital, rehabilitation and skilled nursing facility admissions. These criteria are designed...
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Quality Improvement Program
https://www.caresource.com/members/tools-resources/quality-improvement/qip/...used by America’s health plans to measure important dimensions of care and service and allows for comparisons across health plans in meeting state and federal performance measures and national HEDIS...
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Become a Participating Provider
https://www.caresource.com/providers/education/become-caresource-provider/...CareSource is expanding into other states and is looking to build the provider network for those areas. Follow the links to the states above and fill out the New Health...
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Mental Health
https://www.caresource.com/members/education/behavioral-health/...(SUD). PHP may be given in a hospital setting. It may be offered if you were recently in the hospital. It can be one-on-one and group therapy. If you are...
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FAQs
https://www.caresource.com/providers/education/faqs/...Department of Community Health’s (DCH’s) central prior authorization portal for communicating prior authorization and precertification requests and their disposition. How do I request a retrospective review? Health partners have 180...
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central State Hospital