...office. Find your local county office here. Questions? Call your local DFCS office if you have questions. This must be handled by your local DFCS office. Visit staycovered.ga.gov Note: Please...

...your CareSource coverage. You will find: Details about your Benefits and Services. Plan Documents, such as your member handbook and evidence of coverage online for quick access. Information about our...

...review determinations are based only on appropriateness of care and service and existence of coverage. CareSource does not reward health care partners or our own staff for denying coverage or...

...for COB within 90 days of receiving the updated information that the primary coverage has been terminated Example: Claim for date of service 6/15/16 was denied on 7/10/16 due to...

...printed items in some other languages. Let us know. We can help. Covered Services What kind of services are offered through CareSource Life Services® program? One of the services offered...

...the clinical practice guidelines, CareSource will perform a review of a minimum random sample of fifty members’ medical records per each of the three evidence-based clinical practice guidelines each quarter....

...appropriate use of these medications. CareSource partners with Express Scripts to help manage prescriptions. CareSource uses evidence-based guidelines to ensure health care services and medications meet the standards of excellent...

...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....

These medical policies apply to the CareSource plan. Medical policies offer guidance on determination of medical necessity and appropriateness of care for approved benefits. Benefit determinations and coverage decisions are...

...redetermination of the original request. Full details on coverage determinations and appeals can be found in the Evidence of Coverage (Chapter 9, section 6). Find this and other documents on...