Check Eligibility

We recommend that you check member eligibility each time a member presents for services, as member eligibility can fluctuate. Changes in health status such as pregnancy or certain medical conditions may also cause changes in plan eligibility.

You can always verify member eligibility by accessing the HAP CareSource™ provider portal or through an eligible Electronic Data Interchange (EDI) clearinghouse.

Member ID Card

The member ID card is used to identify a member; it does not guarantee eligibility or benefits coverage. Members may disenroll from HAP CareSource and retain their previous ID card. Members may lose Medicaid eligibility at any time.

Member Consent

When you check eligibility on the HAP CareSource provider portal, you can also determine if a member has granted consent to share sensitive health information (SHI). SHI is a subset of protected health information (PHI) which may require consent from the individual in order to be shared with others.

When a member has a sensitive health diagnosis (e.g., treatment for drug/alcohol use, genetic testing, HIV/AIDS, mental health 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.