The frequently asked questions below are intended to help First Tier, Downstream and Related Entities (FDR) understand and manage their compliance efforts. Please click on the expandable menus below to...

...CareSource complies with all Center of Medicare and Medicaid Services (CMS) payment policies and National Coverage Determinations (NCDs). In the absence of a NCD, CareSource follows the applicable Local Coverage...

...and exceeding state and federal claims payment metrics. Through an ongoing emphasis on getting things right the first time, CareSource ranks among industry leaders in operational efficiency. <0.5 <0.01% 96%...

...door. Medicare Prescription Payment Plan: Pay out-of-pocket prescription costs in monthly payments over the plan year instead of all at once at the pharmacy. List of Covered Drugs (Formulary) If...

...our services and operations. CareSource – An Industry Leader in Operational Excellence CareSource is among the best in the nation at meeting and exceeding state and federal claims payment metrics....

...readiness and retention of military families. Delivering Operational Excellence for Providers We consistently outperform industry benchmarks in key operational areas, ensuring fast, accurate claims payments and unparalleled service. Explore Military...

...for covered services provided to you for which DCH or CareSource does not pay the provider that gives the services. To not be held liable for payments of covered services...

...their health care costs. This is called a copayment or copay. Preferred drugs have a $0.50 copay. Non-preferred drugs are cost-based. Learn more about cost-based copays. Bring your member ID...

...at least 30 calendar days prior to the intended effective date of the change. To be protected from liability for payment of any fees that are the obligation of the...

...the formulary? Yes, if you believe you are entitled to payment or benefits on a certain drug, you can request a coverage determination. A coverage determination is a decision made...