Check Eligibility
We recommend that you check member eligibility each time a member presents for services, as member eligibility can fluctuate. Changes in health status such as pregnancy or certain medical conditions may also cause changes in plan eligibility.
| Important Tools & Resources | |
| Provider Portal | Member ID Card |
You can easily verify member eligibility by accessing the Provider Portal or through an eligible Electronic Data Interchange (EDI) clearinghouse. | The member ID card is used to identify a member; it does not guarantee eligibility or benefits coverage. Members may disenroll and retain their previous ID card. |
Quick Tips: Member Consent
- When you check eligibility on the Provider Portal, you can also determine if a member has granted consent to share sensitive health information (SHI).
- When a member has a sensitive health diagnosis (e.g., treatment for drug/alcohol use, genetic testing, HIV/AIDS, or sexually transmitted diseases), you should verify if the patient has granted consent to share health information. On the portal a message displays on the Member Eligibility page if the member has not consented to sharing sensitive health information (SHI).
- Please encourage CareSource members who have not consented to complete the Member Consent/HIPAA Authorization form so all providers involved in their care can effectively coordinate their care.
- The Member Consent/HIPAA Authorization Form can also be used to designate a person to speak on the member’s behalf. This form is located on the Member Forms page.