Provider Complaints

applicable statutory, regulatory and contractual provisions, collecting all pertinent facts from all parties and applying the CareSource written policies and procedures. Providers are permitted to submit grievances to CareSource regarding CareSource’s policies, procedures or any aspect of CareSource’s administrative functions. All provider grievances should be clearly documented. Matters involving denials or claims payment should be submitted through the appropriate claim payment dispute or appeals process.

Submit Grievances via the Provider Portal

Fast Facts:

• Providers have 30 calendar days from the date of the incident to file a provider grievance.
• CareSource will resolve all provider grievances within 30 days.
• CareSource executives with the authority to require corrective action are involved in the provider grievance process.
• CareSource also allows providers to consolidate grievances or appeals of multiple claims that involve the same or similar payment or coverage issues, regardless of the number of individual members or payment claims included in the bundled grievance or appeal.