State Hearing and External Review

External Review Process

If you are unhappy with a CareSource decision made in response to an internal appeal you filed, you may request an external review. In most cases, you must go through all of the steps in the internal appeal process before you can ask for an external review.

External reviews are conducted by independent review organizations. You do not have to pay for an external review and you will not be subject to retaliation for requesting an external review.

You or your Authorized Representative must ask for an External Review through us within 120 days of the date the denial is issued by us. All External Review requests must be in writing. If you need to ask for an Expedited External Review, you can do so by calling or faxing us. You will also need to authorize the release of your medical records to conduct the External Review.

You or your Authorized Representative may send a written request for an External Review to:

CareSource, Attention: Indiana Member Appeals
P.O. Box 1947
Dayton, OH 45401
Phone: 1-833-230-2099

If you or your Authorized Representative would like to file an Expedited External Review, you may submit your request for expedited External Review verbally by calling us at 1-833-230-2099.

Your request for an External Review must include the following information:

1. The member’s name and member ID number as shown on the ID Card;
2. The Provider’s name;
3. The date of the Health Care Service;
4. The reason you disagree with the Adverse Benefit Determination or Final Adverse Benefit Determination; and
5. Any documentation or other written information to support your request.

NOTE: You may file only one request for External Review of your denial (Adverse Benefit Determination or Final Adverse Benefit Determination).
NOTE: The Expedited External Review can also be done at the same time as an Expedited Internal Appeal.