Provider Policies
CareSource maintains medical, payment and administrative policies for our health partners. We use Indiana Administrative Code, IHCP policies and MCG guidelines, as appropriate and applicable, to determine medically necessity. These policies are regularly reviewed, updated, withdrawn or added; and therefore, subject to change.
Note: The policies below are in PDF format. If you do not have Adobe Acrobat Reader, you may download it here.
Administrative
Administrative policies offer guidance for determining medical necessity, investigational and experimental services.
Medical
Medical policies provide guidelines for determining medical necessity and appropriate care for approved benefits.
Pharmacy
Pharmacy policies provide guidelines for prescription drugs.
Reimbursement
Reimbursement policies provide guidance for claim payments.