Patient Administration

We realize that you perform administrative tasks in addition to tasks directly related to patient care.

To assist you with these tasks, we’ve consolidated the information below.

Member Billing 

State and federal regulations prohibit health care providers from billing CareSource Medicaid members for covered services provided to them. CareSource monitors this activity based on reports of billing from members.

Please note: CareSource covers Medicaid copayments for its Ohio members. No CareSource Ohio Medicaid member should be charged a copayment for any type of Medicaid service.

Covered Services

Regulations state that providers must hold members harmless in the event that CareSource does not pay for a covered service performed by the provider unless CareSource denies prior authorization of the service and the provider notifies the member in writing that the member is financially responsible. This must be done prior to providing the service, and the member must sign and date the notification.

Non-Covered Services

If the CareSource member requests a service not covered by Medicaid, the provider may charge the member for the service as long as the member has been told prior to receiving the service that it was not covered.

If the provider does not tell the member that the service is not covered until after it has been rendered, the provider cannot bill the member.

Missed Appointments

In compliance with federal and state requirements, CareSource members cannot be billed for missed appointments. CareSource encourages members to keep scheduled appointments and call to cancel, if needed.

Please call our Care Management department at 1-800-993-6902 if you are concerned about a CareSource member who misses appointments.

Please call Provider Services for guidance before billing members for any services. You can reach Provider Services at 1-800-488-0134.

As a CareSource provider, you are required to respect the rights of our members. CareSource members are informed of their rights and responsibilities via their member handbook. Please review our members’ rights and responsibilities and ensure your practice is in compliance.

Member Rights & Responsibilities

As a CareSource provider, you are required to respect the rights of our members. CareSource members are informed of their rights and responsibilities via their member handbook.

Please review our members’ rights and responsibilities and ensure your practice is in compliance.