...submit an expedited appeal. Documentation for Good Cause for late filing of an appeal will be reviewed. An AOR form or equivalent is required for expedited preservice appeals if submitted...

...authorized representative must complete the Appointment of Representative form or the Internal Appeal Request form. Return the completed form to us along with your grievance, appeal, or request for an...

...missing information Faster feedback on claim status Minimal staff training or cost Three types of claims may be submitted: Professional medical office claims Institutional claims Instructions for Network Providers: Submitting...

...Form to be part of Network in those states. Welcome to our plan. We work with our providers to provide the highest quality of care for our members. We are...

...Office of the Ombudsman The CareSource Office of the Ombudsman is an independent, neutral department within CareSource that serves the needs of CareSource members, providers and other stakeholders. The Office...

...is important to verify member eligibility before providing services. Patients must be eligible CareSource® members at the time of service in order for services to be covered. CareSource offers several...

...If your first appeal is denied or if you disagree with any part of our appeal decision, you can ask for further appeal levels. Grievances This is an official complaint....

...Login > ProviderProviderProviderProvider Select your appropriate state Click Check Enrollment StatusCheck Enrollment StatusCheck Enrollment StatusCheck Enrollment Status Enter your NPI and Application ID The tool will allow you to review...

...or decrease in level of care with CareSource’s Medical Director/Behavioral Health Medical Director or designee within five business days of the notification of the determination. The peer-to-peer process is independent...

...decision. There are 5 levels of appeals. Details of these levels can be found in Chapter 9 in sections 8 and 9 of the Evidence of Coverage on our Plan...