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Drug Formulary
https://www.caresource.com/providers/tools-resources/drug-formulary/...Medicaid’s covered OTC list. Additional information on pharmacy claim submission and prior authorization is available on the Pharmacy page. Drug Formulary Changes Each quarter, there may be changes to the...
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Prior Authorization
https://www.caresource.com/providers/provider-portal/prior-authorization/...RadMD’s website. Pharmacy Prior Authorization Some drugs may require prior authorization before they will be covered. Please refer to the Pharmacy page to review these requirements. For drugs processed through...
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Collaborative Care Model (CoCM) Initiative
https://www.caresource.com/providers/education/patient-care/behavioral-health/about-the-collaborative-care-model-cocm-initiative/...billed on a HCFA 1500 form and on a claim that does not contain other service codes outside of these four codes. Billing these codes does not guarantee payment. Providers...
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Forms
https://www.caresource.com/providers/tools-resources/forms/...Prior Authorization Form Submit this form to request prior authorization to prescribe Hyaluronic Acid Injections covered and reimbursable by CareSource. Ohio Department of Medicaid (ODM) Pharmacy Prior Authorization Forms Visit...
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Electronic Visit Verification
https://www.caresource.com/providers/education/patient-care/electronic-visit-verification/...12 Exemptions When the above codes are billed in the below scenarios, the claims are not subject to EVV validation: Telehealth: Home Health and Private Duty Nursing services provided through...
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Fraud, Waste and Abuse (FWA)
https://www.caresource.com/about-us/legal/corporate-compliance/vendor-compliance/fraud-waste-and-abuse-fwa/...fraud, waste and abuse. If you have any questions about these examples or Fraud, Waste and Abuse in general, please send an email to: Fraud@CareSource.com. Provider: Billing for non-covered, medically...
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Claims
https://www.caresource.com/providers/provider-portal/claims/...list of valid service codes. You will use this paper claim process until you can log in to the provider portal and access your service plan. To ensure that we...
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Tools & Resources
https://www.caresource.com/providers/tools-resources/...more. View Forms Provider Administered Drugs Look up coverage of medications covered under the medical benefit on the Procedure Lookup tool and review policies on the Pharmacy Policies page Provider...
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Benefits and Services
https://www.caresource.com/plans/marketplace/benefits-services/Please select your state. CareSource plans provide comprehensive, quality coverage that you can afford, understand and use. We offer individual and family plans with adult vision and fitness coverage. Benefits...
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covered codes