Check Eligibility
We recommend that you check member eligibility each and every time a member presents for services, as member eligibility can fluctuate. Changes in health status such as certain medical conditions may impact plan eligibility and coverage.
| Important Tools | |
| 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 CareSource® Dual Advantage™ (HMO SNP) ID cards display member copays for office visits. The member ID number must be included when billing for services to avoid claim rejection. |
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, mental health or sexually transmitted diseases), you can verify if the patient has granted consent to share health information on the Provider Portal. If the member has not consented to sharing sensitive health information, a message will display on the Member Eligibility page.
- The Member Consent/HIPAA Authorization Form can also be used to designate a person to speak on the member’s behalf.
- Please encourage CareSource members who have not consented to complete the Member Consent/HIPAA Authorization Form so that all providers involved in their care can effectively coordinate their care.
For questions not addressed on our website, please call Provider Services at 1-833-230-2176. You can reach us Monday through Friday from 8 a.m. to 6 p.m. Eastern Time (ET).