Claims

We want to make it as easy as possible to conduct business with us. In addition to information about how to submit claims and check payments, CareSource offers you tools to find specific information, such as claim status and member coordination of benefits (COB) status. 

CareSource accepts claims in a variety of formats, including online and paper claims.

Recommended Option: Submit Claims Online

Providers have the option to submit claims through our secure, online Provider Portal. You can submit claims, track claim payments, upload documentation, and more. CareSource offers this service at no cost.

Submit Claims Online Using the CareSource Provider Portal

We encourage you to submit claims online to take advantage of the following benefits:

• Faster claim processing
• Reduced administrative costs
• Reduced probability of errors or missing information
• Faster feedback on claim status
• Minimal staff training or cost

Get Paid Electronically

CareSource has partnered with ECHO Health, Inc. to deliver provider payments. ECHO offers three payment options:

1. Electronic fund transfer (EFT) – preferred
2. Virtual Card Payment (QuicRemit) – Standard bank and card issuer fees apply*
3. Paper Checks

*Payment processing fees are what you pay your bank and credit card processor for use of payment via credit card.

Enrollment Instructions

Enroll with ECHO for payment and choose EFT as your payment preference for CareSource.

Questions? Call ECHO Customer Support at 1-888-834-3511.

Alternative Method: Paper Claims

For the most efficient processing of your claims, CareSource recommends you submit all claims electronically. Paper claim forms are encouraged only for services that require clinical documentation or other forms to process. Refer to the Provider Manual for instructions to submit paper claims.

Non-Participating Providers

Providers who are not in the CareSource network must complete the Non-participating Provider Profile Form in order to submit claims. After we receive your profile, you will receive credentials to log in to the Provider Portal, where you can submit claims electronically.

Emergency Room Claims

The following services will be considered emergency room (ER) autopay and processed without a copayment:

• ER services received after the member calls the 24-hour nurse line and is referred to the ER
• ER services received based on a referral from the member’s primary medical provider (PMP)
• Claims received from a provider for services that have been pre-determined by CareSource to be emergent, and are billed according to the “Condition Related to Accident” or “Emergency UB04” indicators.

Claims for all other ER services go through prudent layperson review and may be subject to a copayment. If the prudent layperson review determines the service was not an emergency, CareSource will reimburse for the medical screening examination and facility fee only, and a copay will be applied. Providers can submit medical records or other supporting documentation within 120 days following the date of payment of the screening fees for re-consideration by the prudent layperson. This documentation should be submitted through the CareSource Provider Portal.

High-Dollar Claims

Providers are required to submit this cover sheet and itemized statement for high dollar claims.