...or your doctor may be asked by us to provide medical records showing that the drug you’re taking is being used for prevention. Remember, if you improperly classify the drug,...

...we make about the payment for a Part D drug or an exception to our formulary. Organization Determination – A decision we make about covering a medical service (Part C...

...Faster feedback on claim status Minimal staff training or cost Three types of claims may be submitted: Professional medical office claims Institutional claims Instructions for Network Providers: Submitting Claims to...

...vendors for goods or services Preventing members from accessing covered services resulting in underutilization of services offered Altering/destroying member materials, medical records, etc. Backdating forms The Federal False Claims Act:...

...Patient Experience Guide (CAHPS resource guide) CPT II Coding Guide Clinical Practice Guidelines CareSource adopts nationally recognized clinical practice and preventive health guidelines from federal agencies and medical professional specialty...

...Statewide Uniform Preferred Drug List or SUPDL. Click the Find My Prescriptions link to see more details on how medicines and medical supplies are managed. Find My Prescriptions Search Prescriptions...

...follow it. Mail to: PeachCare for Kids® Independent Medical Review Request Georgia Department of Community Health Division of Medical Assistance 2 Martin Luther King Jr. Drive, SE 19th Floor, East...

...Vision web site at https://superiorvision.com/eye-care-professionals/join/. CareSource will continue to administer medical optometry. All medical services that fall within the optometrist scope of practice will be reimbursed at 100% of the...

...aspects of care and for all health care information, unless otherwise required by law. To be provided a copy of their medical records, upon request, and to request corrections or...

...responsibility policy. Be treated with respect and with regard for your dignity and privacy. Be sure your personal information and medical records are kept private. Be free from any form...