We strive to make partnering with us simple. We’re aware things may change in the way we do business with you and want to communicate these changes to you in...

...Performance Improvement program, you are rewarded for providing better value for services and achieving better health outcomes for our members. HEDIS Coding Guides To ensure HEDIS measures are captured when...

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...

...(NPI) for Ordering, Referring and Prescribing (ORP) Providers 06/26/2025 Navigating EVV Claims Success: Join Our Office Hours for Claim Guidance 06/26/2025 Prior Authorization Requirement Update 06/20/2025 Coding Documentation Guides Available...

...Patient Experience Guide (CAHPS resource guide) CPT II Coding Guide Clinical Practice Guidelines CareSource adopts nationally recognized clinical practice and preventive health guidelines from federal agencies and medical professional specialty...

...updated to promote accurate coding and policy clarification. These proprietary policies are not a guarantee of payment. Payments for claims may be subject to limitations and/or qualifications. Payment will be...

...the same service Intentionally using improper medical coding to receive a higher rate of reimbursement Billing for services not provided Scheduling more frequent return visits than are needed Unbundling services...

...reimbursement rates Bill for tests or care that you did not have Use wrong medical coding on purpose to get more money Plan more visits than are needed Bill for...

...Not Recognized If the first claim that CareSource receives is for a global delivery, the claim will deny for invalid coding. The provider will need to re-bill, within 90 days...

...Diagnostic Testing for Influenza Virus Infection and Streptococcus A and B 05/13/2020 Active COVID-19: Coding and Billing for Testing Services 04/21/2020 Active COVID-19: CDC Health Alert on Chloroquine 04/07/2020 Active...