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General Plan Information
https://www.caresource.com/plans/marketplace/plan-documents/general-plan-information/...would otherwise be entitled. Federally Recognized Tribes If you are a member of a federally recognized tribe and your household income is at or below 300% of the federal poverty...
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Utilization Management
https://www.caresource.com/providers/education/patient-care/utilization-management/...Necessity Criteria CareSource of North Carolina Co. utilizes nationally recognized criteria to determine medical necessity and appropriateness of inpatient hospital, rehabilitation and skilled nursing facility admissions. These criteria are designed...
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Patient Care
https://www.caresource.com/providers/education/patient-care/...resources that help us work together to provide the best care for our members. Health Care Links – Reference nationally recognized clinical practice and preventive health guidelines from TRICARE Prime...
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Quality Improvement
https://www.caresource.com/providers/education/quality-improvement/...Committee and may face other directed intervention or penalties up to and including contract termination. Preventive and Clinical Practice Guidelines CareSource approves and adopts evidence-based nationally recognized standards and guidelines...
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Provider Responsibilities
https://www.caresource.com/providers/education/health-equity/provider-responsibilities/...that social determinants of health are recognized as significant contributors to member outcomes and quality of life. CareSource PASSE adheres to the National Culturally & Linguistically Appropriate Standards (CLAS). The...
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Quick Reference Materials
https://www.caresource.com/providers/tools-resources/quick-reference-materials/...Patient Experience Guide (CAHPS resource guide) CPT II Coding Guide Clinical Practice Guidelines CareSource adopts nationally recognized clinical practice and preventive health guidelines from federal agencies and medical professional specialty...
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Additional Benefits and Services
https://www.caresource.com/plans/marketplace/benefits-services/additional-services/...and most recognized networks for vision care in the country. EyeMed is our exclusive network of providers for annual vision exams and glasses or contacts for our pediatric vision coverage,...
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FAQs
https://www.caresource.com/providers/education/faqs/...Not Recognized If the first claim that CareSource receives is for a global delivery, the claim will deny for invalid coding. The provider will need to re-bill, within 90 days...
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Provider Disputes or Appeals
https://www.caresource.com/providers/provider-portal/appeals/...49-4-153(e), or Select binding arbitration by a private arbitrator who is certified by a nationally recognized association that provides training and certification in alternative dispute resolution as described in O.C.G.A....
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Health and Social Partnerships
https://www.caresource.com/providers/education/health-equity/...and social needs of the member and understand that social determinants of health (SDoH) are recognized as significant contributors to member outcomes and quality of life. HAP CareSource and HAP...
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