...Physician reviewers from CareSource of Carolina Co. are available to discuss individual cases with attending physicians upon request. Utilization review determinations are based only on appropriateness of care and service...

...2021 Jan; 44 (Supplement 1): S1-S2 Geriatric Medicine Geriatric Medicine Clinical Recommendations & Guidelines American Academy of Family Physicians (AAFP) Heart Failure 2022 AHA/ACC/HFSA Guideline for the Management of Heart...

...and abuse situations. From the Office of the Inspector General The Office of the Inspector General (OIG) has created free educational materials to assist in teaching physicians about the federal...

...requires. Please specify if you believe the request is urgent and include all necessary clinical documentation to support expeditious review. Medical Benefit Fax: 1-888-399-0271 Prior authorization requests for physician administered...

...management A PCP shall provide: Availability of a personal physician to assist with coordination of a member’s overall care, as appropriate for the member Continuity of the member’s total health...

...and physicians not involved in any prior review. They are also reviewed by practitioners with expertise and knowledge appropriate to the item, service, or drug being requested. Pre-Service Appeal: Denial...

...Management department. Please call 1-833-230-2101 for any questions related to post-stabilization services. Advanced Imaging Prior Authorization Ordering physicians must obtain prior authorization for the following outpatient, non-emergent diagnostic imaging procedures:...

Providers who wish to contract with CareSource® must first be credentialed. Through credentialing, we check the qualifications and performance of physicians and other health care practitioners. Providers are recredentialed a...

...performance of physicians and other health care practitioners. Providers are recredentialed a minimum of every three years and are considered to be recredentialed unless otherwise notified. Finish Onboarding Learn how...

...evaluates the quality of health care that health plans provide to their members and how well a health plan manages all parts of its delivery system — physicians, hospitals, other...