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Fraud, Waste & Abuse
https://www.caresource.com/providers/education/fraud-waste-abuse/...and abuse situations. From the Office of the Inspector General The Office of the Inspector General (OIG) has created free educational materials to assist in teaching physicians about the federal...
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Become a Participating Provider
https://www.caresource.com/providers/education/become-caresource-provider/...documents. Providers who wish to contract with CareSource® must also be credentialed. Through credentialing, we check the qualifications and performance of physicians and other health care practitioners. Providers are recredentialed...
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Health Care Links
https://www.caresource.com/providers/education/patient-care/health-care-links/Clinical Practice Guidelines CareSource approves and adopts evidence-based nationally accepted standards and clinical practice guidelines to help inform and guide the provision of clinical care to members. CPGs are identified...
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Utilization Management
https://www.caresource.com/providers/education/patient-care/utilization-management/...a physician’s medical judgment about individual patients. CareSource of North Carolina Co. defaults to all applicable state and federal guidelines regarding criteria for authorization of covered services. CareSource of North...
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FAQs
https://www.caresource.com/providers/education/faqs/...on your Welcome letter. In general, using clean claim forms with legible print will allow for more efficient processing. How soon will I know if my claim was paid? All...
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Primary Care Provider Roles & Responsibility
https://www.caresource.com/providers/education/patient-care/pcp-roles-responsibilities/...Provider Types To qualify as a PCP, a provider must practice in one of the following primary care areas: General practice Family practice Internal medicine Pediatrics Obstetrics/gynecology A specialist may...
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Provider Disputes or Appeals
https://www.caresource.com/providers/provider-portal/appeals/...the CareSource Utilization Management department. You may submit clinical appeals pre- or post-service. All pre-service appeals are clinical appeals, and if not submitted by a physician or physician’s representative, require...
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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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Quick Reference Materials
https://www.caresource.com/providers/tools-resources/quick-reference-materials/CareSource wants to equip you to work with our health plan to provide the best service for our members. The following materials will help familiarize you with the CareSource Ohio...
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Pharmacy
https://www.caresource.com/providers/education/patient-care/pharmacy/...management (MTM) program for all members. MTM services allow local pharmacists to work collaboratively with physicians and other prescribers to enhance quality of care, improve medication compliance, address medication needs...
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general physicians