...more. Call Member Services to ask about our list of covered medications and those that need prior authorization. Medication Therapy Management, or MTM, is a service we offer at no...

Let us know if you are unhappy or do not agree with a decision made by us or our providers. We want to make it right. Please call Member Services...

...you know we got your appeal. The people making appeal decisions are not part of prior reviews or decision making. They are health care professionals. They are supervised by our...

...You should get urgent care from the nearest and most appropriate health care provider. Emergency care is covered both in and out of our service area. Prior to seeking urgent...

...We prioritize people over profits, channeling resources back into members, providers, communities, and employees. For more information, take a look at our Partner with Purpose contracting brochure. This resource reviews...

...to verify procedures and payment mechanisms are compliant. Our proactive monitoring includes prepay review edits, prior authorization monitoring, analytic performance dashboard monitoring, and verification of services. Our reactive monitoring includes...

...will not pay for claims for dates of service prior to the credentialing approval date. Contracting Upon a provider’s interest in contracting with CareSource, the process below is followed: CareSource...

At CareSource, we bring true partnership to Georgia providers. As part of our network, you can expect accurate claims processing, efficient prior authorizations and the dedicated commitment of a nonprofit...

...is important to verify beneficiary eligibility using their Beneficiary ID card and our provider portal prior to each service rendered. We recommend that you check member eligibility each and every...

...Health Equity Accreditation provides an actionable framework for helping health systems continuously improve—and prioritize—health equity for the members and communities we serve. NCQA LONG-TERM SERVICES AND SUPPORTS (LTSS) DESTINCTION Michigan...