The Provider Portal makes it easier for you to work with us 24/7. It has critical information and tools to save your practice time. This helpful online tool is available for all CareSource Ohio plans.
If you are not already registered for the Provider Portal, please register here. You can refer to the Portal Registration Training Module for step-by-step instructions.
If you have a login but cannot remember your username and/or password, please call the CareSource Provider Services Department at 1-800-488-0134.
Cut down on clutter and go green! Register for CareSource Provider E-Communication System and receive relevant and timely information via email. Please register here.
The Centers for Medicare & Medicaid (CMS) has mandated that managed care plans publish additional data elements in its MyCare provider directories. CareSource is working to demonstrate compliance and needs your assistance. ACT NOW by logging on to the provider portal and clicking on the “Accessibility Directory Survey” link. For more information please see the related network notification.
In order to utilize the CareSource Provider Portal, you must use Internet Explorer version 8, 9, 10 or 11 browser. We do not support Internet Explorer version 7. You may also use Google Chrome and FireFox browsers.
Great news, Electronic Funds Transfer (EFT) is now available for all CareSource health partners! Simply complete the enrollment form and fax it back to InstaMed, who will work directly with health partners to enroll in EFT. Free EFT training is also available to CareSource health partners through InstaMed during the enrollment process.
CareSource will begin requiring ICD-10 codes on claims for services to members beginning October 1, 2015. At the same time, the Ohio Department of Medicaid will require health partners performing infant deliveries to use gestational codes and appropriate obstetrics procedures and diagnoses on delivery claims on the mother. You can find more information from ODM at
If you have questions, please contact your Health Partner Representative or call (800) 488-0134. Thank you for your help.
In an effort to assist our health partners in the transition to ICD-10, CareSource has created thumb drives containing helpful links and information. Drives were sent to many health partners via US Mail. Others may be hand-delivered by your Health Partner Representative. We are excited to work with you during this transition.
CMS has published coding guidelines for ICD-10 claims. CareSource has adopted the CMS guidelines as our standard and will require providers to submit claims which are consistent with CMS guidelines.
The link to these guidelines are below:
Effective August 24, 2015, the email address to send Patient Liability Reconciliation spreadsheets and supporting documentation will change from firstname.lastname@example.org to MyCarePL@caresource.com. Please update your contact info according. The Patient/Client Liability Reconciliation spreadsheet is used to report patient/client liability errors or discrepancies for claims paid by MyCare Ohio health plans. As noted on the spreadsheet, you must submit documentation of the correct patient/client liability (for example, a 9401 form, COLA report, report from AAA).
Effective August 20, 2015, CareSource will require that both electronic and paper corrected claims are submitted with the original claim number for acceptance. In an effort to ensure health partners avoid unnecessary rejections or denials, as well as delays in the processing and payment of corrected claims, we have posted a Network Notification with instructions on how to submit the original claim number by EDI or paper form. Please click here to access the full communication.
Effective July 1, 2015, the Ohio Department of Medicaid implemented new nurse and aide service rates, which impact Ohio Medicaid and MyCare plans. Please click here to access the full communication about the rate changes, new modifiers and new codes.
Health partners now have a new tool to request prior authorizations for some procedures. Use the Cite® Auto Auth tool to input clinical details and receive a decision in just seconds! Learn more with our Network Notification.
Effective May 4, 2015, CareSource is implementing a policy change requiring prior authorization for some interventional pain management procedures and CPAPs for dates of service beginning May 4, 2015. For more information, please read our Network Notification.
If you are unable to log in to the Provider Portal and access your service plan, use this form to expedite your claims payment. Click here for instructions to complete the form and for a list of valid service codes. After you complete the paper claim form, you may either mail it or fax it for processing:
CareSourceAttn: Claims DepartmentP.O. Box 8730Dayton, OH 45401-8730Fax: 937-224-3388
You will use this paper claim process until you can log in to the Provider Portal and access your service plan. For training on the Provider Portal claims submission process, access the training module below. The MyCare Ohio Provider Portal User Guide provides instructions to log in to the portal and submit claims.
To ensure that we have the most up-to-date service plan for our MyCare members, please fax your service plan to 937-487-0936. This number is only for service plans and NOT claims submissions.
The attached training module provides an overview of the CareSource® MyCare Ohio Service Plan and Claims Submission. Please review the material for a quick training session!