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General Plan Information
https://www.caresource.com/plans/marketplace/plan-documents/general-plan-information/...services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers can bill you is your plan’s in-network cost-sharing...
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Quality Improvement
https://www.caresource.com/providers/education/quality-improvement/...members with an emphasis on accessibility to care, availability to care, availability of services and physical and behavioral health care delivered by network practitioners and providers. CareSource also monitors the...
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Where To Get Care
https://www.caresource.com/members/tools-resources/where-to-get-care/...plan. You have options when you need to get care. CareSource works with certain doctors and providers to get you care. We call these in-network providers. To have your health...
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Access & Availability Standards
https://www.caresource.com/providers/provider-portal/access-availability-standards/...evaluation of the availability, accessibility and acceptability of services rendered to members by participating providers. We expect network providers to have procedures in place to see patients within time frames...
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Primary Care Provider Roles & Responsibility
https://www.caresource.com/providers/education/patient-care/pcp-roles-responsibilities/...literacy and other communication needs Governance, Leadership and Workforce Communication and Language Assistance Engagement, Continuous Improvement & Accountability Network providers must ensure that: Members understand that they have access to...
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Claims
https://www.caresource.com/providers/provider-portal/claims/...PNM. Providers can submit an application for screening, enrollment, and credentialing through ODM PNM & Centralized Credentialing | Ohio Medicaid Managed Care. Prior Authorization Requirement Non-participating (out-of-network) providers must obtain...
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Newsletters & Communications
https://www.caresource.com/providers/education/newsletters-communications/...ProviderSource Newsletter Fall 2024 ProviderSource Newsletter Spring 2024 ProviderSource Newsletter Spring 2024 ProviderSource Newsletter NCQA Annual Insert Winter 2023 ProviderSource Newsletter Fall 2023 ProviderSource Newsletter Spring 2023 ProviderSource Newsletter Spring...
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Provider Disputes or Appeals
https://www.caresource.com/providers/provider-portal/appeals/...payment and any other post-service claim denial. CareSource pays non-contracted providers, as Medicare would have paid for the same service. If your disagreement is limited to the amounts a non-contracted...
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FAQs
https://www.caresource.com/members/education/faqs/...PCP to another provider up to once a month. Or use the Find A Doctor tool to find all providers in our network. Contact Us How can I contact CareSource?...
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Prior Authorization
https://www.caresource.com/providers/provider-portal/prior-authorization/...Non-Participating Providers Prior authorization must be obtained before sending patients to nonparticipating providers, with the following exceptions. Emergency Services All in-patient services require prior authorization. Please call 1-833-230-2101 to obtain...
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