...Generic Tier 3: Preferred Brand Tier 4: Non-Preferred Drug Tier 5: Specialty Tier Prior Authorization Review Process CareSource MyCare Ohio will process coverage determinations and exception requests in accordance with...

...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...

...Ohio: Ohio Department of Medicaid (ODM) – 1-614-466-0722 Medicaid Fraud Control Unit (Mfcu) – 1-800-282-0515 The Ohio Auditor Of State (AOS) – 1-866-Fraud-OH or by email at fraudohio@ohioauditor.gov Employee Ethics...

...Funds Transfer – Now Available for All Ohio Providers 08/12/11 CareSource Plan for 5010 Transition 07/26/11 Ohio Debarred Attestation 07/18/11 NDC Requirements for Physician Administered Drugs in an Office Setting...

...Medical Director for further review and determination. Physician reviewers from CareSource of Carolina Co. are available to discuss individual cases with attending physicians upon request. Utilization review determinations are based...

...Pregnancy: Safer Medication Use Treating for Two: Medicine and Pregnancy Centers for Disease Control and Prevention Perinatal Quality Collaborative Ohio Perinatal Quality Collaborative Behavioral Health Guidelines Health Condition Clinical Guideline...

...Program design is to ensure the organization delivers on all aspects of care delivery for CareSource MyCare Ohio members based on their unique needs. We monitor, analyze and identify opportunities...

...payer claim adjustment group codes as reported on the 835 payment or as identified on the EOP, such as deductible, coinsurance, copayment, contractual obligations and/or non-covered service group codes. Adjustment...

...tools and resources by visiting our Provider Welcome page. Attention Ohio Medicaid and MyCare Providers: Ohio Medicaid and MyCare providers should utilize the Provider Network Management (PNM) module from the...

...you are responsible for making full payment to the Non-Network Provider. The fact that a physician has performed or prescribed a procedure or treatment, or that it may be the...