...decision 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...

...not by CareSource. There are two ways in which the funds are distributed: Advance Premium Tax Credit (APTC) A tax credit based on income level that lowers monthly premium payments....

...dispute a decision. Prescription Reimbursement Claim Form – Use this form to ask for repayment for a prescription drug you paid for. Fraud, Waste and Abuse Reporting Form – Use...

...All provider complaints should be clearly documented. Matters involving denials or claims payment should be submitted through the appropriate claim payment dispute or appeals process. Providers have 30 calendar days...

...copayment level, we will update our system so that you can pay the correct copayment when you get your next prescription at the pharmacy. If you overpay on your copayment,...

...same service. Non-contracted providers have the right to request a reconsideration of the plan’s denial of payment: Non-contracted providers have 60 calendar days from the remittance notification date to file...

The Public Health Emergency (PHE) for COVID-19 has ended. Services like vaccines, treatment, and testing are still available. Some rules changed, stopped, or started again. CareSource continues to watch COVID-19...

...CareSource Live Instructor-Led Provider Training and Education Series – UPDATE 03/17/2023 ODM EDI Claims and Bridge Payments for Providers 03/14/2023 Medicaid Coverage Redetermination Resumes April 1 03/10/2023 Pregnancy Risk Assessment...

...DSNP patients in your practice! Here’s how you can start earning these payments: STEP 1: LEARN ABOUT THE QUALITY ENHANCER PROGRAM To start earning flu shot payments, we recommend you...

...an ineligible good or service, any duplicate payment, any payment for a good or service not received (except for such payments where authorized by law), and any payment that does...