Provider Policies
HAP CareSource maintains medical, payment and administrative policies for our health partners.
These policies are regularly reviewed, updated, withdrawn or added; and therefore, subject to change.
Please check often for updates to health partner policies.
Policies may vary by plan and/or state. Click the links to access policies for your member’s plan.
The policies presented on these pages may not be inclusive of all applicable provider policies. Some benefit management services are provided on behalf of HAP CareSource. Please reference applicable policies from our delegated service providers.
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.