Provider Manual and Materials
CareSource has many materials for providers. Please click on the appropriate link to open them. All forms are pdf files unless otherwise specified.
CareSource has removed the prior authorization requirements for the unlisted procedure CPT code listing; however, we require a clinical record be submitted with your claim to review the validity of the unlisted procedure CPT code. Claims submitted without clinical records for unlisted procedure CPT codes will be denied. Denials will be reconsidered through the appeal process with pertinent clinical records. Please see the list of unlisted procedure CPT codes that meet this guideline for review.
Please Note
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Reference Documents
CareSource Corporate Compliance Plan
Dental
Dental Handbook (effective July 1, 2008)
Orthodontic Evaluation and Pre-Determination Form
Orthodontist Confirmation Form
Dental Claims Form
Prior Authorization Request for Dental Services (link to ODJFS website, Form JFS 03612)
Revised Prior Authorization List
Dental Webinar Presentation
Medical
2008 Synagis Webinar - 09/24/08
Provider Manual
Hospital Manual
Services that Require Prior Authorization
Provider Field Rep Services and Territory
Sample EOP statement
Unlisted Procedures Codes
Pharmacy
Drugs that Require Prior Authorization (effective June 1, 2008)
Master Drug List (effective July 1, 2008)
Frequently Asked Questions about Formulary Changes
Forms
Medical
Case Management Referral
Provider Information Update Form
Abortion Certification Form
Consent to Hysterectomy Form (link to ODJFS website, Form JFS 03199)
Consent to Sterilization Form (link to ODJFS website, Form JFS 03198)
Online Prior Authorization Request (** Do not use this for Pharmacy requests)
Prior Auth Request Form- Medical Paper Form (**Do not use this form for Synagis or Pharmacy requests**)
Synagis Prior Authorization Request Form
Medical Necessity Appeal Request Form
Standardized ODI Credentialing Form (link to form on ODI website)
Confidential Fraud and Abuse Reporting Form
PCP Member Fax Form
Prior Authorization Form for Home Health Care Services
Pharmacy
Prior Authorization Request Form - Online Request Form
Prior Authorization Request Form - Print and Fax Form
Health Management and Medical Record Documentation Tools
Healthchek Checklist
Prenatal Risk Assessment Form
Prenatal/Postpartum Management Checklist
Asthma Management Progress Note
Asthma Management Quarterly Progress Note
Asthma Patient Action Plan (English)
Ashtma Patient Action Plan (Spanish)
Preventive and Clinical Practice Guidelines
For CFC members
Preventive Guidelines Ages 0-21 (American Academy of Pediatrics website)
CMS - EPSDT Benefits Overview
Preventive Guidelines Ages 18-65+(American Academy of Family Physicians website)
CDC Recommended Immunization Schedule for Persons Aged 0 – 18 Years
CDC Recommended Immunization Schedule for Persons Aged Over 18 Years
Practice Guidelines for Asthma
Asthma EPR2 Quick Reference-2002 Update
Practice Guidelines for Diabetes
Algorithm for Depression Treatment
Algorithm for Depression Pharmacotherapy
Algorithm for Suicidal Ideation Assessment
For ABD members
Practice Guidelines for Asthma
Reference Guide for Asthma
Practice Guidelines for Cholesterol Education
Practice Guidelines for Atherosclerotic Cardiovascular Disease
Practice Guidelines for Chronic Heart Failure
Practice Guidelines for Chronic Obstructive Pulmonary Disease
Practice Guidelines for Treating Major Depression
Practice Guidelines for Diabetes
Practice Guidelines for Non-mild Hypertension
Practice Guidelines for Severely Mentally Disabled
Practice Guidelines for Substance Abuse
ProviderSource Newsletters
Summer 2008
Spring 2008
Fall 2007
Spring 2007
Winter 2006
Summer 2006
Spring 2006
Spring 2008 Quarterly Mail Letters
Spring 2007 Quarterly Mail Letters
Winter Quarterly Mail Letters