Frequently Asked Questions
Our contract with the Indiana Office of Medicaid Policy and Planning expired as of December 31, 2006.
CareSource will continue to pay provider claims throughout the run out period. Our claims submission timelines remain the same at 180 days for participating providers and 365 days for non-participating providers. In addition, CareSource's standard appeals process will remain in place throughout the claims run-out period. Our current provider manual and other provider forms can be found on this website and will be accessible through the end of 2007.
For assistance with claims issues, please contact:
Provider Services
Hours: 10 a.m. to 2 p.m., Monday – Friday
Phone: 1-866-930-0017
Fax: 1-877-725-4547
Please keep in mind that CareSource is committed to paying claims within prompt pay requirements, and will do so unless additional information is needed to process the claim or the claim involves medical necessity review or coordination of benefits. Our Coordination of Benefits (COB) unit can be reached by fax at (937) 396-3139 or by e-mail at cobindiana@csmg-online.com. During the transition period, we will not respond to claims status request for claims less than 45 days old.
We thank you for your partnership with CareSource and wish you the best as you move forward in supporting the Hoosier Healthwise program.
Can I ever bill my CareSource patients?
OMPP regulations prohibit health care providers from billing any Hoosier Healthwise recipients, including members of CareSource, for any services. The OMPP does allow providers to charge Hoosier Healthwise recipients in Package C a co-payment for some services.
Please be aware that CareSource will cover any co-payment for its Package C members. No CareSource member of any type should ever be charged a co-payment for services.
For more information, please see Billing Policy.
How do I check member eligibility?
To verify member eligibility, providers can:
- Call the EDS automated voice response (AVR) system. EDS, Indiana’s fiscal agent for Medicaid, has an AVR system that can be reached 24 hours a day from any touch tone phone. Just call 1-800-738-6770 and follow the menu prompts.
- Log onto the EDS Web interChange . You may inquire about eligibility by Hoosier Health ID number, social security number, or name and date of birth.
- Use an OMNI 380 terminal, usually referred to as an OMNI swipe card device, to run the patient’s Hoosier Health ID card. Note: EDS can no longer provider new terminals, but technical support for existing terminals is available by calling 1-800-284-3548.
- Submit a fax to our provider service center at 1-877-725-4547.
- Call our provider service center. If you cannot confirm a member’s eligibility with the above methods, please call our provider service center at 1-866-930-0017 and select the option for verifying member eligibility. Please have the member’s name and Hoosier Health ID number ready.
For more information, please see Check Member Eligibility.
How do I submit a claim?
CareSource accepts paper claims on the following forms:
- CMS 1500 , formerly HCFA 1500 form — AMA universal claim form also known as the National Standard Format (NSF).
- CMS 1450 , formerly UB92 form (for hospitals).
Paper claim forms can be handwritten, typed or computer generated. Please send all paper claim forms to:
CareSource
P.O. Box 10310
Dayton, OH 45402
Attn: Claims Department
CareSource accepts electronic claims in the following file formats:
- NSF version 1.01, professional claims.
- UB92 version 4.0, hospital claims.
- 837 ANSI x 12 (HIPAA compliant) hospital or professional EDI management software , including translation and communications software, enables computers to perform EDI transactions accurately and efficiently.
Please use your CareSource provider billing number on all claims. This is simply your Hoosier Healthwise billing number followed by a location code. If you are unsure of your provider billing number, please contact our provider service center Monday through Friday 10 a.m to 2 p.m. at 1-866-930-0017.
To submit claims electronically, providers must work with an electronic claims clearinghouse. CareSource currently accepts electronic claims from Indiana providers through WebMD. Please contact WebMD at 1-800-845-6592 or www.webmdenvoy.com.
For more information, please see Submit a Claim.
How do I file a medical necessity appeal?
A medical necessity appeal is a formal request for CareSource to reconsider a decision not to cover a treatment or procedure because it is not medically necessary. Providers have up to 30 days after receiving a letter denying coverage to submit a medical necessity appeal.
Medical necessity appeals should include:
- The member’s name, Hoosier Health ID number, and date of birth.
- The provider’s name and CareSource provider billing number.
- The type of service for which CareSource denied coverage, and the date and place when it was to be provided.
- The reason CareSource’s decision to deny coverage should be reconsidered.
- Any additional medical information to support your request.
Please submit medical necessity appeals to:
CareSource
One S. Main St.
Dayton, OH 45402
Attn: Claims Department -- Medical Necessity Appeal
CareSource resolves standard medical appeals within 15 days. Providers may ask CareSource for expedited medical appeals by calling the provider service center at 1-866-930-0017 and following the prompts (2 to speak someone about prior authorization, then 4 for medical appeals). CareSource resolves expedited medical necessity appeals in three days.
For more information, please see Medical Necessity Appeals.
How do I file a claims dispute?
Providers who are unhappy with CareSource’s decision or action concerning a claim have 60 days to file a written objection and request an informal claims dispute resolution. The written notice of the dispute must include an explanation of what they provider is objecting to and why.
Providers may send the notice to:
CareSource
One S. Main St.
Dayton OH 45402
Attn: Claims Department – Informal Dispute
If the claims dispute is not resolved to the provider’s satisfaction within 30 days of submitting it for informal resolution, or within 30 days of submitting additional documentation, the provider then has up to 60 days to submit the matter to the formal claims dispute resolution.
To submit a claim to the formal dispute resolution process, a provider simply has to give written notice to CareSource. Providers may send the notice to:
CareSource
One S. Main St.
Dayton OH 45402
Attn: Claims Department – Formal Dispute
If providers are unhappy with the outcome of the formal claims dispute, they may seek binding arbitration.
For more information, please see Claims Disputes.