Provider Policies
We maintain medical, payment and administrative policies for our health partners. Policies are regularly reviewed, updated, withdrawn or added; and therefore, subject to change. Please check often for updates to health partner policies.
Click the links to access policies for your member’s CareSource (Common Ground Healthcare) plan.
Note: The policies below are in PDF format. If you do not have Adobe Acrobat Reader, you may download it here.
Administrative
Administrative policies offer guidance for determining medical necessity, investigational and experimental services.
Medical
Medical policies provide guidelines for determining medical necessity and appropriate care for approved benefits.
Pharmacy
Pharmacy policies provide guidelines for prescription drugs.
Reimbursement
Reimbursement policies provide guidance for claim payments.
Musculo and Cardiac Surgical Procedures
Our plans cover both musculoskeletal and cardiac surgeries for our members. Orthopedic, neuro-spine and cardiac providers can access the following tools to help them provide efficient and quality care