Credentialing
Providers who wish to contract with CareSource must first be credentialed. Through credentialing, CareSource checks the qualifications and performance of physicians and other health care practitioners. Providers are recredentialed a minimum of every three years and are considered to be recredentialed unless otherwise notified.
CareSource credentials providers using guidelines from the Ohio Department of Job and Family Services (ODJFS), the National Committee for Quality Assurance (NCQA) and URAC. Our Vice President/Senior Medical Director is responsible for the credentialing and recredentialing program.
CareSource offers two easy ways to become credentialed:
The Council on Affordable Quality Healthcare’s Universal Credentialing DataSource
This system allows providers to enter data one time, at no cost, to satisfy the credentialing and recredentialing requirements of participating health insurance plans. If you use the CAQH service, you only need to select CareSource as an authorized user of your data on the CAQH website and provide a CareSource provider relations representative with the authorization number required to access it. For more information, please log on to the CAQH website or call CAQH at 1-888-599-1771.
The ODI Standardized Credentialing Form
The Ohio Department of Insurance offers this standard form for health care organizations in Ohio as an easy way to keep your information current. It is available online at the ODI website or you may contact a CareSource provider relations representative to request one.
For more information or questions about credentialing, call CareSource at 1-800-488-0134 and follow the prompts to be directed to one of our Credentialing staff. We can research the status of the provider’s application in the credentialing process or what documents might still be needed from the provider. We can answer questions from providers and their staff related to the Credentialing process.
Or you can find more information about credentialing in Provider Manual.