...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...

...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...

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...

...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...

...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...

...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...

...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...

...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...

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...

...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...