Check Eligibility
We recommend that you check member eligibility each and every time a member presents for services, as member eligibility can fluctuate.
| Important Tools & Resources | |
| 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 ID card displays member copays for office visits, Emergency Department (ED), and Urgent Care, as well as Deductible and Member Out-of-Pocket (MOOP) limit details on the front of the card. Please ensure to use the appropriate member suffix when billing to avoid claim rejection. Dependent Member suffixes can be found in front of their name on the ID card and should replace the Member ID’s “-00” suffix. |
Please note: CareSource applies the 90-day grace period to members who have APTC. Members who do not have APTC will have a 30-day grace period. If a member becomes delinquent in premium payments, we will identify this on the Provider Portal. At the end of the first month of the grace period, we will suspend the member’s pharmacy benefits, but continue to pay for medical claims. At the end of the grace period, if the member is terminated due to non-payment of premium, CareSource will recoup any payments made for claims received in the second and third months of the grace period.
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, or sexually transmitted diseases), you should verify if the patient has granted consent to share health information. On the Provider Portal, a message displays on the Member Eligibility page if the member has not consented to sharing sensitive health information (SHI).
- 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. This form is located on the member Forms page.