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Reimbursement Policies
https://www.caresource.com/providers/tools-resources/health-partner-policies/reimbursement-policies/These reimbursement policies apply to the TRICARE Prime® Demo by CareSource Military & Veterans™ plan. Reimbursement policies are designed to assist you when submitting claims to us. They are routinely...
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State Hearing and External Review
https://www.caresource.com/members/tools-resources/grievance-appeal/state-hearing-external-review/...final adverse determination notice) for clinical denials by contacting CareSource and for coverage denials by contacting the Kentucky Department of Insurance. You must ask for an external review within 120...
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Primary Care Provider Roles & Responsibility
https://www.caresource.com/providers/education/patient-care/pcp-roles-responsibilities/All CareSource members choose or are assigned to a primary care provider (PCP) when they enroll in the plan. They can change to another network PCP as often as needed....
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Patient Administration
https://www.caresource.com/providers/education/patient-care/patient-administration/...Providers may not charge members for services which CareSource PASSE™ denied based on lack of medical necessity or lack of compliance to contractual terms. Providers may not bill members for...
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Additional Services
https://www.caresource.com/plans/medicaid/benefits-services/additional-services/...Dental Services Routine dental checkups and dental cleanings are covered under Hoosier Healthwise, HIP Plus, HIP State Plus, and HIP State Basic and HIP Maternity plans. You can find a...
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Where To Get Care
https://www.caresource.com/members/tools-resources/where-to-get-care/...Convenience Care Clinic near you by searching “clinics” in our Find a Doctor tool. Urgent Care Clinics When you get a sudden illness, injury or condition that isn’t an emergency,...
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Tobacco Use & Chronic Disease
https://www.caresource.com/members/education/smoking-cessation/tobacco-use-chronic-disease/...HIV/AIDS. Tobacco, in all forms, also causes many other health issues. These issues can be: Heart disease. Cancer Breathing problems. Dental problems. Eye and ear problems. Bone problems. Reproductive problems....
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MA-Dual Special Needs
https://www.caresource.com/plans/dsnp/...delivered directly to you at no extra cost for many prescriptions. Dental Dental $4,000 annual allowance for preventative services such as oral exams and cleanings as well as services like...
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During Pregnancy
https://www.caresource.com/members/education/pregnancy/during-pregnancy/...your OB provider about? Check out this guide for vaccinations during pregnancy. Go to routine dental visits During pregnancy, keeping your teeth and gums healthy can become a challenge. This...
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Marketplace
https://www.caresource.com/plans/marketplace/...care Pregnancy, maternity and newborn care Mental health and substance use disorder services Rehabilitative and habilitative services and devices Laboratory services Pediatric services, including dental and vision Optional Adult Vision...
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