Our Program Integrity Department handles cases of managed care fraud, waste or abuse. It can be done by providers, pharmacies, or members. Fraud means the purposeful misuse of or for...

...Department of Health Resources Please select your state resources below for specific COVID-19 vaccine guidance. Arkansas Department of Health Georgia Department of Public Health Indiana Department of Health Kentucky Public...

...of our health plan and the Ohio Department of Medicaid (ODM) as outlined in this manual. Providing 30 days of emergency coverage to any CareSource patient dismissed from the practice....

...activities, providing transparency and visibility into care and services. The EDI transaction process has been modernized as part of the Ohio Department of Medicaid’s (ODM) efforts to enhance the OMES....

...and earn 10+ hours of free CME/CE credit! Resources CMS Webinars and Trainings US Department of Health and Human Resources (HHS) Think Cultural Health Our Commitment We are committed to...

...with the Georgia Department of Community Health Quality Strategic Plan requirements to improve the health outcomes for all Georgia Families® members. Improved health outcomes are documented using established performance measures....

...Abuse and Mental Health Services Administration (SAMHSA) – The Substance Abuse and Mental Health Services Administration (SAMHSA) is the agency within the U.S. Department of Health and Human Services that...

...minimum of every three years and are considered to be recredentialed unless otherwise notified. Contracting and Recredentialing Process CareSource credentials providers using guidelines from the Ohio Department of Insurance (ODI)...

...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...

...for Drug Abuse (NIDA) Opioids Opioid Crisis and Pain Management U.S. Department of Health and Human Services National Association of Drug Diversion Investigators Learning Library Naloxone Resources CareSource Naloxbox Initiative...