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Medical Policies
https://www.caresource.com/providers/tools-resources/health-partner-policies/medical-policies/...laws. The medical policies do not constitute medical advice or medical care. Treating health care providers are solely responsible for diagnosis, treatment and medical advice. CareSource is not responsible for,...
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Archived Medical Policies
https://www.caresource.com/providers/tools-resources/health-partner-policies/medical-policies/archived/The policies below are in PDF format. If you do not have Adobe Acrobat Reader, you may download it here. # A B C D E F G H I...
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Archived Administrative Policies
https://www.caresource.com/providers/tools-resources/health-partner-policies/administrative-policies/archived/...Determinations Medical Necessity Determinations Medical Necessity Determinations Medical Necessity Determinations Medical Necessity Determinations Medical Necessity for Medical Benefit Medications Medical Necessity for Non-Formulary / Non-Preferred Medications Medical Necessity for Non-Formulary...
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Medical Benefits
https://www.caresource.com/benefits-services__trashed/medical/...– $10 copay Specialist $0 – $50 copay $0 – $35 copay Other Medical Benefits (In-Network) Inpatient Hospital Care Days 1-5: $380 per day Days 6-90: $0 copay per day...
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Dr. David Williams, Executive Vice President and Chief Medical Officer
https://www.caresource.com/about-us/executive-leadership/dr-david-williams-executive-vice-president-and-chief-medical-officer/...the University of Pittsburgh School of Medicine. He is a member of many professional societies including the American College of Physicians, the American Medical Association and the National Medical Association....
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Medical Benefits
https://www.caresource.com/plans/dsnp/benefits-services/medical-benefits/...member of our plan you must use network providers to get your medical care and services. View Chapter 3 Using the plan for your medical and other covered services in...
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Part C Medical Plan Rights
https://www.caresource.com/members/tools-resources/grievance-appeal/part-c-medical-plan-rights/Organization Determinations (Decisions) A decision we make about the coverage of a service. If you believe you are entitled to a medical service (Part C or Medicaid) you can request...
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Quality Improvement
https://www.caresource.com/providers/education/quality-improvement/...quality issue reviews. Medical record requests are forwarded to providers via mail, e-mail or fax and may be returned to CareSource via these same mechanisms as detailed in the medical...
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Provider Disputes or Appeals
https://www.caresource.com/providers/provider-portal/appeals/...appeal to deny, limit, reduce, suspend, or terminate a covered service for lack of medical necessity may request an External Medical Review with Permedion. Services denied, limited, reduced, suspended, or...
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Utilization Management
https://www.caresource.com/providers/education/patient-care/utilization-management/...will provide the clinical rationale or criteria used in making medical necessity determinations. You may request the information by calling or faxing the CareSource Medical Management Department. If you would...
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