Coordination of Benefits
CareSource has contracted with Health Management Systems (HMS) to identify CareSource members who have other insurance coverage and to make sure claims are paid by the appropriate primary carrier.
You may receive correspondence from HMS regarding coordination-of-benefit issues. Please remember that CareSource, as a Medicaid plan, is the payer of last resort after commercial health insurance carriers as well as Medicare.
HMS conducts most of this business directly with other insurance carriers. In rare instances, HMS may request patient medical documentation from your office to verify for the other carrier that a service was provided. CareSource may need to recover inappropriate payments from hospital providers in some circumstances when another carrier is found liable. We expect these occasions to be limited and we appreciate your cooperation with HMS requests if you should receive any.
We ask that you take measures to obtain third-party liability information from CareSource members. Please bill the appropriate carrier before billing CareSource.
After you receive the third-party payment or denial, you can bill CareSource for the remainder of the balance. Please include a copy of the carrier’s explanation of benefits. Even third-party zero-balance claims and Explanations of Benefits (EOBs) must be submitted to CareSource due to state regulations.