...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...

...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...

...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...

...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...

...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...

...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...

...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...

...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...

...(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...

...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...