...non-contracted providers as Medicare would have paid for the same service. Non-contracted providers have the right to request a reconsideration of the plan’s denial of payment: Non-contracted providers have 60...

Appeals Non-participating providers may request reconsideration of a claim denial. You must request an appeal within 90 calendar days of the date of the remittance advice. Non-contracted providers have 90...

We follow all state and federal civil rights laws. We do not discriminate, exclude, or treat people differently based on race, color, national origin, disability, age, religion, sex (which includes...

We follow all state and federal civil rights laws. We do not discriminate, exclude, or treat people differently based on race, color, national origin, disability, age, religion, sex (which includes...

...Authorization Request Form . 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...

...the online Member Exception Request for Non-Formulary Medication. When a non-formulary drug is requested due to drug allergy or intolerance or lack of efficacy of a formulary drug, the prescriber...

...Sheet Submit this cover sheet and itemized statement for high dollar claims. Non-Participating Provider Profile Form (Coming Soon) Non-participating providers may submit claims to CareSource using this form. CareSource is...

...for coverage, a member and the treating provider may not proceed with that service or supply after receiving a denial from CareSource for the requested non-covered service. Existing clinical policies...

...your disagreement is limited to the amounts a non-contracted provider could collect if the beneficiary were enrolled in original Medicare pursuant to § 422.214(a)(l), you should use the plan’s internal...

...for Non-Formulary / Non-Preferred Medications Medical Necessity for Non-Formulary Medications Medical Necessity for Non-Formulary Medications Medical Necessity for Non-Formulary Medications Medical Necessity for Non-Formulary Medications Medical Record Documentation Standards for...