Patient Administration

We realize that you perform administrative tasks in addition to tasks directly related to patient care.

To assist you with these tasks, we’ve consolidated the information below.

Member Grace Period

Members have a federally mandated 90-day grace period if they are receiving APTC, or a 31-day grace period if they are not receiving APTC in which to make their payment.

  • This is not applicable for their initial payment
  • For APTC-receiving members, 30 days after their due date CareSource will: flag the member in the eligibility
    file on the Provider Portal, suspend pharmacy benefits and pend claims rendered
  • For non-APTC members, the day after their due date, CareSource will: flag the member in the eligibility file and on the Provider Portal, suspend pharmacy benefits and pend claims rendered

If members bring their account into good standing before the expiration of the grace period, pharmacy benefits will start again and pended claims will be processed.

Member Rights & Responsibilities

As a CareSource provider, you are required to respect the rights of our members. CareSource members are informed of their rights and responsibilities via their member handbook. Please review our members’ rights and responsibilities and ensure your practice is in compliance.