Filing Timeframes
Participating providers may submit claims up to 180 days after the date of service. CareSource processes an average of 94 percent of clean claims within 30 days of receipt.
If CareSource denies a claim, providers have 90 days from the date they are informed of the unpaid claim to appeal it. Please click on Claims Payment Appeals for more information about appeals.
All third-party zero-balance claims and Explanations of Benefits (EOBs) must be submitted to CareSource within 90 days of the date on the third-party claim or EOB.
If you use a billing service or an electronic data interchange (EDI) clearinghouse to submit electronic claims, please confirm with them the dates that claims are submitted to and received by CareSource. Submission to and acceptance by your billing vendor does not guarantee that claims have been forwarded to and received by CareSource within the 180-day timely filing guidelines.
CareSource has established claim submission timeframes to maintain the quality and integrity of our health plan and our valued partnership with you. We appreciate your adherence to these timeframes which, in turn, will help ensure your timely reimbursement.