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Updates & Announcements
https://www.caresource.com/providers/tools-resources/updates-announcements/...Practice Changes to CareSource 03/26/2025 It's Patient Experience Survey Season 03/14/2025 Hearing Aid Coverage – Ohio House Bill 315 03/10/2025 Provider Connections - Ohio 03/06/2025 Pharmacy Policy Updates March 2025...
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Behavioral Health Carve-In
https://www.caresource.com/providers/education/patient-care/behavioral-health-carve-in/...Authorization process can be found on the CareSource Prior Authorization page. Submit the universal Ohio Association of Health Plans form to request prior authorization for outpatient behavioral health services. Ohio...
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Become a Participating Provider
https://www.caresource.com/providers/education/become-caresource-provider/...Ohio Medicaid and MyCare Providers: Ohio Medicaid and MyCare providers should utilize the Provider Network Management (PNM) module from the Ohio Department of Medicaid (ODM) for submitting provider applications, credentialing...
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Preferred Drug List
https://www.caresource.com/plans/medicaid/benefits-services/pharmacy/preferred-drug-list/...some information. This is called a prior authorization request. It tells us why a certain drug and/or a certain amount of drug is needed. We must approve the request before...
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Plan Documents
https://www.caresource.com/plans/dsnp/plan-documents/...Redetermination Request Form online or hard copy – If you are unsatisfied with the outcome of a coverage determination request, you can file an appeal using the redetermination form. Prior...
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Get Credentialed
https://www.caresource.com/providers/education/become-caresource-provider/get-credentialed/...referenced above: Log on to CAQH using your account information. Select the Authorization tab. Make sure CareSource Medicaid Ohio isCareSource Marketplace Ohio isCareSource Advantage Zero Premium and CareSource Advantage Ohio...
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Plan Documents
https://www.caresource.com/plans/plan-documents/...Redetermination Request Form online or hard copy (Updated 03/01/2021) – If you are unsatisfied with the outcome of a coverage determination request, you can file an appeal using the redetermination...
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Plan Documents
https://www.caresource.com/plans/mycare-snp/plan-documents/...Your provider can submit a request for a prior authorization using the Prior Authorization Request Form (coming soon). If you are seeing a specialist, they will get approval from your...
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Drug Formulary
https://www.caresource.com/benefits-services__trashed/pharmacy/drug-formulary/...of the original request. Full details on coverage determinations and appeals can be found in the Evidence of Coverage (Chapter 9, section 6). Find this and other documents on our...
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Grievances
https://www.caresource.com/members/tools-resources/grievance-appeal/grievance/...users should call 1-877-486-2048 or 711. You may also file a complaint with the Ohio Department of Insurance online or request a complaint form and instructions for filing a written...
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