Caresource medicaid handbook

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Management is very helpful and there is plenty of room for advancement. Some of the job titles with high salaries at CareSource are director of analytics, systems director, architect, and senior software engineer. Enter your last name exactly as it appears on your member ID card.

Requirements are higher than or other medically necessary to demonstrate the forms and may only. What is your email? Your email address will be your username [email protected] Avoid fires from discarded cigarettes. Leadership is a joke, and needs to be clean out the whole house. In this case, the employee asked. The employee handbook and the newer, cooler "culture code" is a great tool for employees, new and existing, to learn the company's mission, values and norms. The difference is the amount of content you must learn from medical coding and billing, appeals, disputes and authorizations.

CareSource offers benefits and […]. Multiple health, dental including orthodontia and vision insurance options. The handbook lays out expectations about everything from the dress code to employee benefits to conduct policy. Find information about retirement plans, insurance benefits, paid time off,. We work to recognize our own biases and have healthy, courageous conversations in order to elevate our collective cultural competence.

Faneuil provide business process outsourcing to a number of sectors including healthcare, social programs, and transportation. A handbook should serve as a guide for not only a company to protect itself, but it should provide specific guidance and expectations for all employees.

Providing our employees with access to health care. List of CareSource Employees. The employee handbook is an opportunity to welcome new employees, provide information about the company and affirm company values. Division of Human Resource Management. Employees in Dayton have rated CareSource with 3. Please see below for our many resources, policies, and tips to make your Zoo visit as fun and comfortable as possible.

As a salaried employee I am able to flex time, if I need to run out during the day I can use. At CareSource, we are more than just quality health insurance.

CareSource is a nonprofit, multi-state health plan recognized as a national leader in managed care. For decades, Superior Vision has been providing comprehensive vision care benefits to millions of Americans. Employee Handbook. Take a listen and see if it makes you happy. In addition to policies and procedures that impact the. CareSource takes very good care of their employees. These handbooks detail and outline the rules and regulations of each organization in a clear, concise manner that should be easily understood by all company employees.

Which benefits does CareSource provide? This handbook is a decent mix of culture and heavy on policy. As a result, every employee handbook is unique to the company it represents. This manual communicates policies and programs and outlines key information such as claim submission and reimbursement processes, authorizations, member benefits and more to make it easier for you to do business with us.

Hours of Operation and Holidays CareSource is open for business 8 a. CareSource makes up reason to lay you off, fire you, or take your very large financials gains you worked for away because they were not doing what they were suppose to. The information provided in this Member Handbook is meant.

And while companies do use employee handbooks to deliver various policies and regulations to new hires, the employee handbook has evolved to. Employee handbooks are an important tool for communicating information about workplace culture, benefits, attendance, pay practices,. We administer one of the nation's largest Medicaid-managed care plans and offer access. Set the tone: positive, collaborative with an emphasis on clear communication. And Definitions High If anyone reading this is suicidal, call them.

Management doesn't follow their own company handbook or even know where. CareSource is a leading nonprofit multi-state health plan serving government sponsored programs and is nationally recognized as an industry leader in providing member-centric health care coverage.

The Member Handbook is a quick reference guide to your health care benefits. CareSource recommends expanding benefits to include programs that directly address recipient SDOH, support recipient employment, and improve. Member Handbook. Physical exam required for employment or for participation in job training.

I assist with the employee hiring process, participate in the development and implementation of HR policies and procedures with leader oversight, and actively. An employee handbook helps new employees learn about the company rules, policies, culture, and values. Short-term and long-term disability insurance, with buy-up options. An employee manual that goes over the head of company employees defeats its purpose and should be revised or completely re-written until it is comprehensible.

The provider manual is a resource for working with our health plan. Free Employee Handbook Template. No regard for state rules and regulations. CareSource does not represent or warrant, whether expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. CareSource is a nonprofit that began as a managed health care plan serving Medicaid members in Ohio.

Simply put, an employee handbook is a document that clearly outlines a company's policies, procedures, and general company culture. EBMS Employee Benefit Management Services is a third-party administrator of self-funded health plans, committed to driving change in this evolving.

Find information about retirement plans, insurance benefits, paid time off, reviews, and more. Employee Smoking Policy Template. Entrata's employee handbook. Current and former employees report that CareSource provides the following benefits. CareerSource Florida provides policy for programs administered by DEO, Florida's local workforce development boards and their career centers.

Password must contain at least one number, one lowercase letter, one capital letter and one special character such as! Members and Providers are disregarded. Policies should be written, reviewed by legal counsel, and released to every employee contracted or hired by the company. CareSource has an overall rating of 3. We know that life can be hectic. Find out what you should be paid. CareSource "call center" Reviews. Join the world's top companies using Zoominfo. Not all tools listed will be available to all plan or program participants.

Working at CareSource: Reviews about Management. Medicaid: Managed Care Plans. Georgia individuals and families looking for affordable health insurance can now consider CareSource health plans.

View the benefits you have as a CareSource member at-a-glance here. CareSource Employee Benefits and Perks. Visit My CareSource, your personal, online account. Please update your favorites with our new website. Use our tool to get a personalized report on your market. Monday through Friday, except for holidays. According to the National Law Review, employee handbooks are not required by law, but help reduce employment law risks.

Employer bereavement policies may need to change. CareSource is an equal opportunity employer and gives consideration for employment to qualified applicants without regard to race, color, religion, sex, age, national origin, disability, sexual.

Employee Handbook Best Practices In Review existing policies to ensure that they are up to date, mistake-free, and fair. Delightful renovated rural property set in 15 acres with a river, pool, main residence and gites, in a beautiful tranquil setting in the Perigord Vert. The current Medicare and Medicaid services are confusing and difficult to navigate and there is not a single entity which is accountable for the whole person.

MyCare Ohio dual benefits members also only have to carry one medical coverage card. MyCare Ohio offers members: one point of contact, person-centered care, seamless across services and settings, easy navigation for members and providers, and wellness, prevention, coordination and community-based services.

The MyCare Ohio plan benefit package includes all benefits available through the traditional Medicare and Medicaid programs, including long-term care services both in the community and in a nursing facility as well as behavioral health services.

What about medical services I already have approved or scheduled? What if my doctor or hospital is not in the MyCare Ohio plan network? MyCare Ohio plans are required to provide transition of care benefits for non-contracted providers of many services, including physician and pharmacy.

After the transition period, members must utilize providers who are within the MyCare Ohio plans provider network. If you have full Medicaid eligibility and you are having difficulty in getting to a medically necessary service, then you may request transportation assistance.

The type of assistance available may depend on whether you are a member of a Medicaid managed care or MyCare Ohio plan, in which county you live, and whether you are bringing along a non-folding wheelchair or power scooter that doesn't fit easily in a standard vehicle. Medicaid managed care and MyCare Ohio plans can offer free transportation to their members as an additional benefit above and beyond what the state requires.

This "value-added" benefit can be limited to a specific number of trips a year. Members may take these trips to get to healthcare appointments and other services as well, but no one is required to use them up or even to use them at all.

If you are a member of a Medicaid managed care or MyCare Ohio plan, then contact your plan in any of the following circumstances: You use a non-folding wheelchair or power scooter that doesn't fit easily in a standard vehicle or you need to sit in your folding wheelchair during transport. You must travel 30 miles or more one way because the medically necessary treatment covered under your plan is not available at a closer location.

You have a value-added ride available that you want to use. More information on Transportation Assistance. What happens now? When you move to a county that does not have MyCare Ohio, enrollment in MyCare Ohio will end on the last day the month. What should I expect to receive from my MCP as a new member? Once you are enrolled in a MCP, you will get a welcome letter and your member identification ID card in the mail.

Keep this card while you are on the plan. The MCP will also send you information about your doctors, health services, and scope of coverage. As an MCP member, you can also request a member handbook.

You will also receive other communications from your MCP, including newsletters, health care reminders, opportunities to earn wellness incentives, and more. If you order a card via telephone, it should arrive in the mail in business days from the date of your request. Your provider requests prior approval from the MCP.

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Through a partnership with Fuyao Glass America , the company was able to set up interviews for 40 members for full-time employment with the manufacturing company. This new approach informed the way CareSource began to see its members. In , CareSource began serving members in West Virginia through its health exchange product and was awarded the contract to serve Medicaid populations in Indiana [27] and Georgia.

The growth in membership was matched by growth in the number of employees. A lease was signed for some employees to move into space on two floors of the Kettering Tower, which was renamed Stratacache Tower in , [28] in downtown Dayton to make room for a total of 2, employees in the city.

The new building would provide space for employees and create a campus-like environment in the urban core. In CareSource became the largest locally owned company by revenue in the Dayton-area after Marathon Petroleum Corp. The CareSource Foundation celebrated its 15th Anniversary in Headquartered in Dayton, Ohio, CareSource has a workforce of 4, employees and covers nearly 2 million members.

There are satellite offices in the Ohio cities of Cleveland and Columbus , as well as Atlanta , Indianapolis , and Louisville, Kentucky. From Wikipedia, the free encyclopedia. Health Insurance Provider. Dayton, Ohio. United States. Ernst and Young. Dayton Business Journal. Cincinnati Business Courier. Retrieved Columbus Business First. Archived from the original on November 20, Archived from the original PDF on Archived from the original on Dayton Daily News.

Modern Healthcare. Dayton Local. CEO Today. Ohio Department of Medicaid. Ohio Medicaid. CareSource Newsroom. Authority control ISNI 1. Hidden categories: CS1 errors: missing periodical All articles with dead external links Articles with dead external links from May Articles with short description Short description matches Wikidata All articles with unsourced statements Articles with unsourced statements from September Articles with ISNI identifiers.

Namespaces Article Talk. We believe that treatment works. And we can help you find treatment with an experienced provider. CareSource behavioral health services can help you cope with all kinds of issues. Call Member Services for the names and telephone numbers of available providers, including self-referral or PCP referral, and facilities near you. You can also refer to your provider directory or visit CareSource. Please see the benefits section to learn more.

Good dental care is a key part of your health. We encourage you to get a checkup every six months. Routine dental exams can help find and correct any problems before they get worse. CareSource covers two dental exams each year. Caring for your eyes can lead to a better quality of life. Your eyesight impacts your performance at work, school, and home. Routine checkups and services from an eye doctor, as well as glasses, are covered by CareSource.

CareSource will not pay for services or supplies received that are not covered by Medicaid. If you have a question about whether a service is covered, please call Member Services at TTY: or We are open Monday - Friday from 7 a. CareSource will review applicable OAC rules e. Your managed care plan will review all requests for services from your provider. At CareSource, we care about you.

We know that there is more to health and well-being than just great health care. The following benefits at-a-glance lists the covered care and services you have as a CareSource member. Mental health and substance use disorder treatment services are available through the plan.

These services include:. This means that CareSource must approve the service before you receive it. This means that your PCP or other health care provider will recommend or request these services for you before you can get them. These services are available at no cost to you.

Ambulance Transportation for emergency situations by Non-emergency ambulance services require and Ambulette ambulance or an Ambulette, a wheelchair van a PA. Transportation is covered. You can also call Member Adults Services to learn more. Chiropractic Services for your back. No PA is required. Call Member for children Services for more information. Additional replacements may be allowed if damage and unable to repair or if need driven by rapid growth and member is under 18 years of age.

Emergency An emergency is a medical problem you think No PA is required for emergency services. Services is so serious that it must be treated right away by a doctor. Emergency Services are always covered. Learn more on page Family Planning Services like birth control, breast pumps, Infertility diagnostic services require a PA.

You may self-refer for these covered. Qualified Health care and specialists services, physical Center or Rural therapy services, speech pathology and Health Clinic audiology services, dental services, podiatry Services services, vision services, chiropractic services, transportation, and mental health services.

Call Member Services for available qualified centers in Ohio, find one in your Provider Directory, or at findadoctor. Free-Standing Birth Center Home Health Home health care is a wide range of health These services require a PA including but not Services care services that can be given in your home limited to : for an illness or injury.

Only inpatient hospice care requires a PA. Inpatient Inpatient hospital services are medical All inpatient hospital services require a PA. Hospital procedures or tests that are done in a hospital Services or other medical center and usually require an overnight stay. Medical Supplies Covered care includes diabetic supplies and These services require a PA including but not nutritional supplies.

Services unless the Ohio Department of Medicaid determines that the member will return to fee-for-services Medicaid and if the member needs nursing services, they should call CareSource Member Services for information on available providers.

CareSource will not pay for services from these providers unless it is an emergency or we have given PA. Find providers in the CareSource network in your Provider Directory, at findadoctor. Pain Pain management services help improve the These services require a PA including but not Management quality of life for those living with chronic pain.

Physical exam A physical exam required for employment or No PA is required. Please see page 41 to Drugs, Including medications are covered. We use a learn more. Prescribed over-the-counter drugs. Mammogram Mammograms and pap smears for women are breast and covered. Cervical Cancer pap smear exams Preventive Preventive care is always covered.

Prostate Screenings for prostate cancer for men are Screening covered. Primary Care Preventive care is always covered. If needed, your PCP will send you to specialists or admit you to the hospital. Renal dialysis Dialysis is covered. Call Member Services to learn more. Respite Services For members under 21 years of age that have PA is required for respite services.

Counseling for are covered. Your PCP or other health Obesity care provider can provide care if medically necessary. Services Services for children with medical handicaps No PA is required. Immunizations treat you for most of your routine health care needs. Specialist Includes services from specialists like Specialists or services outside of the CareSource Services a dermatologist, cardiologist, and other network require a PA.

Find specialists in the CareSource network in your Provider Directory, at findadoctor. Services computer, from wherever you are. Your PCP may offer telehealth. Contact their office to find out. Urgent Care Urgent Care Centers are for non-emergencies. They help keep an injury, sickness, or mental health issue from getting worse.

Vision Optical Includes eye exams, routine checkups, and These services require a PA including but not Services, services from an eye doctor. Well-child Preventive care is always covered. Healthchek exams for Healthchek covers medical exams, children under immunizations shots , health education, the age of 21 and lab tests for Medicaid eligible individuals under the age of Healthchek also covers medical, vision, dental, hearing, nutritional, developmental, and behavioral health exams.

See page 39 to learn more. Yearly Well-adult Preventive care is always covered. Exams Yearly well-adult exams are always covered. Your PCP is your main point of contact for routine care, common illnesses, and advice. Your PCP may also offer telehealth. Your PCP is an individual physician, physician group practice, advanced practice nurse or advanced practice nurse group practice trained in family medicine general practice , internal medicine or pediatrics.

Your PCP will work with you to direct your health care. Your PCP will do your check-ups and shots and treat you for most of your routine health care needs. If needed, your PCP will send you to other doctors specialists or admit you to the hospital.

The Provider Directory is a list of doctors and other health care providers who accept CareSource insurance and see patients who are covered through CareSource. Our Provider Directory is updated regularly so providers may have been added or removed since it was printed.

You can find the most up-to-date list of providers in the CareSource network by using our online Find a Doctor tool at findadoctor. If you are a new patient to your PCP, please call their office to set up an appointment. This will help your PCP get to know you and understand your health care needs right away. You should also have all of your past medical records transferred to your new doctor. You can request a printed provider directory by calling the Member Services department or by returning the postcard you received with your new member booklet and member identification ID card.

The Provider Directory lists all of our network providers as well as other providers outside of the CareSource network that you can use to receive services. You can also visit our website at findadoctor. We can help you find a PCP or send you a printed directory. We hope you are happy with the PCP you have chosen, but we know that you may decide to choose a different PCP in the future.

If for any reason you want to change your PCP, you must first call Member Services to ask for the change. You can change your PCP as often as once a month, if needed.

We will process your change on the day you call. Member Services can also help you schedule your first appointment, if needed. For the names of the PCPs in the CareSource network, you may look in your Provider Directory if you requested a printed copy, on our website at findadoctor. If your PCP tells us that they are moving, retiring, or leaving CareSource for any reason, we will assign another PCP for you and let you know by mail within 45 days when possible.

You can call us if you need help choosing another PCP. We also inform you if any of our network hospitals within your region are no longer in network. Please schedule appointments with your doctor as far in advance as you can. It is important to keep your appointments. If you miss too many appointments, your doctor may ask that you choose another doctor. See page 33 to learn more. Your PCP will play a big role in your preventive care. Routine health exams, tests, and screenings can help find and treat problems early before they get worse.

We want to make sure you have easy access to care from the right health care provider when you need it. Appointment you are. Contact their office not available.

Inside not available. Your very sick or need and advice. May to find out. If your PCP is not many local drug and condition or injury immediate help. For also offer telehealth. Not every situation falls neatly into one of the above options. You should see your PCP for all routine visits. Instead of coming into the office for your appointment, you stay at your home or office and use your smartphone, tablet or computer to see and talk to your medical and behavioral health professionals.

There is no cost for Medicaid members to use telehealth and telehealth removes the stress of needing transportation services. Telehealth is a convenient option for care, and may lower your chance of being exposed to illnesses like the flu.

Using telehealth may give you prompt medical support that can prevent your condition from worsening. Your PCP may offer telehealth services via phone or computer.

Medicaid members can see medical and behavioral health professionals via telehealth for many illnesses and injuries, common health conditions, follow-up appointments and screenings as well as prescribing medication s. Check with your provider to see if they offer telehealth. Have your CareSource member ID number ready when you call. You will need to answer a few questions about the reason for your call.

A doctor will contact you, normally within 15 minutes. A retail visit is quicker and cheaper than a visit to urgent care or an ER.

Most clinics are open in the evening, seven days a week. Visits can be scheduled for the same day. Often walk-ins are welcome. Find one near you using our online Find a Doctor tool at findadoctor. Urgent Care Centers are for non-emergencies.

After you go, always check in with your PCP. Sometimes you get sick or hurt while you are away from home. If you think you need to go to urgent carewhile you are away from home or traveling, call your PCP or CareSource24 at TTY: or They can help you decide what to do.

If you go to an urgent care center, call your PCP as soon as you can to let them know of your visit. We cover care for emergencies, both in and out of the county where you live. You can use any hospital or other appropriate setting for emergency services. You do not have to contact CareSource for an okay before you get emergency services.

Be sure to tell them that you are a member of CareSource and show them your ID card. Then call your PCP or Member Services as soon as you can after the visit to schedule any necessary follow-up services. Emergency Department services are covered. However, if you are admitted and the facility is not in the CareSource network, you may be transferred to a hospital in the Caresource network once you are stable.

You may need more care after your emergency. This is called follow up care. If you have a Care Manager, let them know. They can help you transition back home and schedule follow up visits. CareSource will talk to the doctors that give you care during your emergency.

The doctors will tell us when your medical emergency is over. They need to tell us if you need more care to treat any problems that may have caused the emergency. Your doctor can tell us by calling Member Services and asking for approval of these services.

If needed, CareSource will cover care for you after your emergency situation 24 hours a day, seven days a week. We want to be sure you continue to improve. If your emergency care was from out-of-network providers, CareSource will work to get network providers to take over your care as soon as possible.

Your PCP is your main health partner. For any routine health care needs, contact your PCP first. See pages for information on services covered by CareSource. Sometimes you get sick or injured when you are traveling. We can help you decide what to do. If you get emergency care from a provider who is not a Network Provider, or urgent care services outside the service area for your plan, you may need to submit the bill you get to CareSource with a claim form.

You can use the Member Claim Form included in the back of this handbook see page CareSource offers care management services that are available to children and adults with special health care needs. The care management team includes registered nurses, social workers, and other outreach workers. They are called Care Managers. Together, we work with you to meet your health and wellness goals. Care management includes different levels of care. The level of care you receive depends on your condition and how much help you need managing your health care needs.

Using a few questions about your health and lifestyle, we can determine the level of care management you may need. Phone: TTY: between 7 a. A business reply envelope was also provided so you can send it back to us. This way, they can help you understand your condition and how to better manage your health. Care Managers can connect you with resources you need like food, clothing, and housing.

They can even help you coordinate transportation to get medical care. Please call us if you have any questions or feel that you would benefit from care management.

You can reach us at TTY: or and asking for care management when prompted. Good health requires more than just quality health care. Having a good job, community support, and access to education or training opportunities impact your overall health and well-being. We can help remove barriers that stand in the way of reaching your goals. Life Services can help pave the way from where you are, to where you want to be.

Life Coaches provide one-on-one coaching for up to 24 months. Your Life Coach will connect with you on an individual level and can address needs beyond physical health to include the home, workplace, and community. Life Coaches can also link you to services and support for:. This is all provided at no cost to you.

To connect with CareSource Life Services, call or email [email protected] To learn more, please fill out our online form at secureforms. Take charge of your mental health and try our online wellness tool called myStrength. This is a safe and secure tool designed just for you. It offers personalized support to help improve your mood, mind, body and spirit. You can access it online or on your mobile device at no cost to you.

You can visit mystrength. Complete the myStrength sign-up process and personal profile. You can also download the myStrength app for Apple and Android devices at mystrength. Your financial health impacts your well-being. Express Banking is a bank account from Fifth Third Bank with no monthly service charge, no minimum balance, no overdraft fees, and a debit card for purchases.

Visit With CareSource24, you have unlimited access to talk with a caring and experienced staff of registered nurses through a toll-free number. You can call TTY: or 24 hours a day, 7 days a week.

CareSource24 is available at no cost to you. The nurses will talk with you about your symptoms. They will help you figure out your next steps for care. Please see page 7 of this handbook for more details. CareSource offers a Disease Management Program.

This program can help you learn about your health and how you can better manage specific health conditions such as asthma, diabetes, and high blood pressure. Our goal is to make sure you have the right tools to stay as healthy as possible. This program is available to you at no cost.

We may receive information from your doctor, drugstore, or other health care provider, letting us know that you would benefit from this program. We will send you materials related to your health condition along with tips for the online MyHealth tool.

We have health guidelines and information for asthma, diabetes, and high blood pressure. We are committed to improving the health and wellness of our members.

KidsHealth gives you easy-to-read articles, videos, interactive health tools, and doctor-reviewed advice on hundreds of health topics. Through MyHealth, adults age 18 and older have access to interactive health assessments, small step interactive guides and videos, and online tools to set and track health and wellness goals. You can even earn rewards for some activities. To get started, simply log in to your MyCareSource account, click on the Health tab and scroll down to the to MyHealth link.

CareSource works with health providers across the state to better coordinate the health and safety needs of our members. The goal of CPC is to provide comprehensive care that addresses all of your needs.

Your PCP will lead and coordinate. In fact, you will benefit from our stronger partnership with providers as they take the lead to help you achieve your health needs and goals. What this means for you is that your care management will be part of a care team located at your PCP office.

This team will be able to help you make medical appointments, get transportation or access community resources. Our goal is to work with CPC providers to deliver the best care possible to our members. Please contact TTY: or for assistance. Request your ride at least 48 hours two business days before your appointment. CareSource also offers additional transportation services, if needed. We cover up to 30 one-way trips per member per calendar year to any health care, Women, Infant Children WIC , or redetermination appointments.

Remember, if you have an emergency, please call or go to the nearest emergency room. In addition to the transportation assistance that CareSource provides, members can still get assistance with transportation for certain services through the local county Department of Job and Family Services Non- Emergency Transportation NET program.

Please review the following information carefully to understand your responsibilities. These rules have been made to help ensure your safety and to avoid transportation delays. Saturday, Sunday, and holidays do not count. This will ensure that the driver has enough travel time so you are not late for your appointment. The driver can wait for only five minutes.

The transportation company reserves the right to take away your transportation benefit for six months after three no-shows within three months. A no-show is defined as:. You are expected to be courteous and show respect to the transportation company and CareSource staff. Improper, discourteous behavior may result in a six-month suspension of the transportation benefit for your family. Improper behavior includes:. CareSource and the transportation company reserve the right to immediately discontinue transportation services to members who violate these guidelines or misuse or abuse the transportation benefit.

Please keep this policy in mind. We want your transportation experiences to be positive. Please call Member Services if you have any questions or concerns. Make life more rewarding! CareSource rewards you and your family for taking a proactive role in being healthy.

We have lifestyle programs to encourage you and your family to take part in yearly wellness visits and preventive care programs. Learn more in the program descriptions below. Simply see your doctor regularly while you are pregnant.

See your doctor for a follow-up exam after your baby is born. And, make sure your child goes to all their well-child visits with the doctor. CareSource wants to make sure you have what you need for each new baby.

Please enroll every time you are pregnant. Once CareSource receives notice from your provider that you and your baby have completed an activity, we will add your reward to your Babies First account.

After registering for the program, watch your mail for details on how to redeem the rewards earned. You can then redeem the rewards for gift cards from one of our many retailers.

As a parent, it is important that your child is as healthy and active as possible. The Kids First Program allows your child ages 18 months to 18 years earn rewards for leading a healthy lifestyle. This includes an annual physical, various vaccines, and routine dental exams. You must Recommended ages years complete the series of three shots to receive the reward. ADHD days of initial prescription years. ADHD diagnosis required. Once CareSource receives notice from your provider that your child has completed an activity, we will add the reward to the Kids First account.

You can then redeem the rewards for gift cards from one of many retailers. This program is available to all adult female members at no additional cost to you. Through the Women First program you have access to personalized health tools called Journeys, the ability to track exercise goals and access to small step guides that help you better understand the health and wellness topics that matter most to you.

Once CareSource receives notice from your provider that you have completed an activity, we will add your reward to your MyHealth account. You can then redeem your rewards for gift cards from one of many retailers. Whether you are thinking about having a baby in the future or you are expecting a baby soon, CareSource wants you to have a healthy pregnancy. Here is how you can take advantage of the services and benefits we have to offer.

CareSource offers direct access to family planning services without a referral. If the provider you want to see is not in the CareSource network, you may need a prior authorization before your visit. Call Member Services to let them know who you will be seeing for your family planning. Screening, diagnosis and treatment of sexually transmitted infections are a direct access service.

This means you can get services for sexually transmitted infections without a referral for the service. If the provider you wish to see is not in the CareSource network, you may need a prior authorization before your visit. If you are thinking of having a baby, you can do some things now to be as healthy as possible before getting pregnant. CareSource can help you to quit smoking during pregnancy or following the delivery of your baby with our Quit for Two program. A trained counselor will work with you throughout your pregnancy and until your baby turns one.

Call to enroll in this program. During Pregnancy If you are pregnant, make an appointment with an obstetrician OB. Be sure to make an appointment as soon as you know you are pregnant. You should also contact your caseworker at your county Department of Job and Family Services. It is also important to have a postpartum checkup with your OB. They will make sure your body is healing and recovering properly after giving birth. Call your OB to schedule an appointment for four to six weeks after your baby is born.

If you had a C-section or had any problems during delivery, make your appointment within the first or second week after your baby is born. Text4Baby Whether you are expecting your first child or your third, many questions may run through your mind before and after your baby is born. Text4Baby can help answer these questions and more.

When you sign up, you will get up to three text messages a week with health and safety tips throughout your pregnancy and until your baby is one year old. Visit text4baby. Healthchek covers medical exams, immunizations shots , health education, and laboratory tests for Medicaid eligible individuals under the age of These exams are important to make sure that children are healthy and are developing physically and mentally.

Mothers should have prenatal exams and children should have exams at:. After that, children should have at least one exam per year. Healthchek also covers medical, vision, dental, hearing, nutritional, developmental, and behavioral health exams, in addition to other care to treat physical, behavioral, or other problems or conditions found by an exam.

Some of the tests and treatment services may require prior authorization. Also, for some EPSDT items or services, your provider may request prior authorization for CareSource to cover things that have limits or are not covered for members over age As a part of Healthchek, care management services are available to all members under the age of 21 years who have special health care needs. Please see pages to learn more about the care management services offered by CareSource.

Make sure to ask for a Healthchek exam when you call your PCP. CareSource asks that you schedule exams for all eligible family members regularly. You should try to schedule the first exam within 90 days of becoming a member. If you would like to learn more about the Healthchek program, please call Member Services.

These are the drugs we prefer your provider prescribes. We must approve the request before you can get the medication. Some drugs may also have quantity amount limits on how much can be given to a member at one time and some drugs are never covered, such as drugs for weight loss. If we do not approve a prior authorization request for a medication, we will send you information on how you can appeal our decision.

You can call Member Services to request information on our PDL and medications that require prior authorization. You can also look on our website at CareSource. To learn more about how to use our pharmaceutical management procedures, look in the summary section of the PDL that can be found on our website. If you do not have access to the internet, please call Member Services and they will be able to assist you.

Typically, our PDL formulary includes more than one drug for treating a particular condition. Many alternative drugs are just as effective as other drugs and do not cause more side effects or other health problems. Step Therapy In some cases, you may need to try one drug before taking another. This is called Step Therapy. Certain drugs will be covered only if Step Therapy is used. Generic Substitution A drugstore will give you a generic drug in place of a brand-name drug.

Generic drugs have the same effect and safety as brand-name drugs. Your provider will need approval from CareSource if they ask for a brand name drug when there is a generic drug available. Other times, a drug might not work for you. In these cases, your provider can ask CareSource to cover a drug that is not on the approved drug list. Sometimes a member might have a drug allergy or intolerance, or a certain drug might not be effective and a non- formulary agent is requested.

The provider will then need to submit a prior authorization request. You may ask us to cover a drug not on the PDL. This is called an exception. You may ask for an exception because of an allergy, not being able to take a drug, or a poor response to the PDL drug.

You or a person. Once we get this request, we will work with your provider to get the forms and information needed. Specialty Medicines There are certain medications that are more complex for diseases that require special attention and need to be handled differently than medications you pick up at your local pharmacy.

Using medications the right way is vital to your health. Drugstores may also reach out to you if they think you could benefit from the program. The pharmacist may set a time with you to review your drugs. This includes any pills, creams, eye drops, herbals, or over-the-counter items you use. They can help you with your drugs and teach you the right way to take them. They also work with your providers. You can take part in the MTM program at no cost to you. Is your medicine cabinet full of expired drugs or medications you no longer use?

Your prescriptions are for you. Expired or unused medications can be a serious health risk for toddlers, teens, or family pets if they are within their reach. They can also be misused by others. Most people who misuse prescription drugs get them from friends or family members.

To learn more, go to takebackday. To see a list of sites near you, visit deadiversion. The program coordinates treatment for members who have high patterns of utilization of both medications and services. Members selected for the CSP will be notified in writing, provided additional information, and notified of their state hearing rights. Accidental Injury or Illness Subrogation If you have to see a doctor for an injury or illness that was caused by another person or business, you must call Member Services to let us know.

When you call be prepared to provide the name of the person at fault, their insurance company and the name s of any attorney s involved. Other Health Insurance Coordination of Benefits — COB If you or anyone in your family has health insurance with another company, it is very important that you call Member Services and your county caseworker about the insurance. For example, if you work and have health insurance or if your children have health insurance through their other parent then you need to call Member Services to give us the information.

It is also important to call Member Services and your county caseworker if you have lost health insurance that you had previously reported. Not giving us this information can cause problems with getting care and with payment of potential medical bills. Please bring all your health insurance ID cards with you to every appointment.

Members with other insurance: CareSource follows Ohio insurance guidelines for members who have other insurance. Your other insurance coverage is considered your primary coverage. CareSource is secondary.

You should follow the guidelines of your primary insurance when you get medical care. Be sure to show your providers and pharmacists both insurance ID cards at every visit. Providers will bill your primary insurance first.

After your primary insurance pays its allowable amount, your provider will bill CareSource. CareSource will pay the remaining amount after the primary insurance payment up to the amount CareSource would have paid as the primary insurance. Loss of Insurance Notice Certificate Of Creditable Coverage Anytime you lose health insurance, you should receive a notice, known as a certificate of creditable coverage, from your old insurance company that says you no longer have insurance.

It is important that you keep a copy of this notice for your records because you might be asked to provide a copy. If this happened, CareSource would be told to stop your membership as a Medicaid member and you would no longer be covered by CareSource. If you have questions about your eligibility, please contact your county caseworker. Transportation can be provided for your redetermination appointment, if needed.

Please see page 33 in this handbook or call our Member Services department for more details. This information may also be available to someone who you have legally approved to have the information, or who you have said should be reached in an emergency when it is not in the best interest of your health to give it to you.

Instances believed to work against your best interest may be overridden. If you say no, the doctor or CareSource must talk to you about what could happen and they must put a note in your medical record about it. See pages of this handbook for information. See pages which explain about advance directives. You can also contact CareSource Member Services for more information.

CareSource must send you something in writing that says who the new PCP is by the date of the change. If a qualified provider is not able to see you, CareSource must set up a visit with a provider not in the CareSource network. If you are approved to go out of network, this is your right as a member and the services will be provided at no cost to you.

Box Columbus, Ohio E-mail: [email protected] Fax: Michigan Ave. Show it when getting care. This notice describes how health information about you may be used and given out. It also tells how you can get this information. Please review it carefully. When it comes to your health information, you have certain rights: Get a copy of your health and claims records. You can also get other health information we have about you.

Ask us how to do this. We often do this within 30 days of your request. We may charge a fair, cost-based fee. Ask us to fix health and claims records. If we do, we will tell you why in writing within 60 days. Ask for private communications. You can ask us to send mail to a different address. Ask us to limit what we use or share.

This is limited to six years before the date you ask. You may ask who we shared it with, and why. If you ask for another within 12 months, we will charge a fair, cost-based fee. Get a copy of this privacy notice. You can ask even if you have agreed to get the notice electronically. We will give you a paper copy promptly. Give CareSource consent to speak to someone on your behalf.

CareSource will give out health information to your legal guardian. We will make sure a legal guardian has this right and can act for you. We will do this before we take any action. File a complaint if you feel your rights are violated. Use the information at the end of this notice. You can send a letter to Independence Avenue, S. We may not require you to give up your right to file a complaint as a condition of: - care, - payment, - enrollment in a health plan, or - eligibility for benefits.

For certain health information, you can tell us your choices about what we share. If you have a clear choice for how we share your information in the situations described below, talk to us.

Tell us what you want us to do. We will follow your instructions. We may share it if we believe it is in your best interest. We may also share your information when needed to lessen a serious and close threat to health or safety. This information is shared to handle your care and treatment or to help with benefits. This information is shared with your past, current, and future treating providers. You have the right to tell CareSource you do.

If you do not agree to share your health information, it will not be shared with providers to handle your care and treatment or to help with benefits. It will be shared with the provider who treats you for the specific SHI. If you do not approve sharing, all providers helping care for you may not be able to manage your care as well as they could if you did approve sharing. How do we typically use or share your health information?

We typically use or share your health information in these ways:. We use it to contact you when needed. We cannot use it to decide the price of that coverage. We may give your health information to outside groups so they can assist us with our business. Such outside groups include lawyers, accountants, consultants and others. We require them to keep your health information private, too. How else can we use or share your health information? We are allowed or required to share your information in other ways.

These ways are often to help the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these reasons. For more information see: www. We can do this as long as certain privacy rules are met. This includes the Department of Health and Human Services if it wants to see that we are obeying federal privacy laws. This includes information that is written, spoken, or available online using a computer. We make sure that only those employees with a business reason to access information use and share that information.

We are required to give you a copy of this notice. We must give you a copy of it. You may change your mind at any time. Let us know in writing if you change your mind. Effective date and changes to the terms of this notice.

The original notice was effective April 14, , and this version was effective June 18, We must follow the terms of this notice as long as it is in effect. If needed, we can change the notice. The new one would apply to all health information we keep. If this happens, the new notice will be available upon request.

It will also be posted on our web site. You can ask for a paper copy of our notice at any time by mailing a request to the CareSource Privacy Officer. Email: [email protected] Phone: TTY: or We hope you will be happy with CareSource and the service we provide. If you are unhappy with anything about CareSource or its providers, you should contact us as soon as possible. This includes if you do not agree with a decision we have made. You, or someone you want to speak for you, can contact us.

If you want someone to speak for you, you will need to let us know this. CareSource wants you to contact us so that we can help you. Be sure to put your first and last name, the number from the front of your CareSource member ID card, and your address and telephone number in the letter so that we can contact you, if needed.

You should also send any information that helps explain your problem. If you do not agree with the decision or action listed in the letter, and you contact us within 60 calendar days to ask that we change our decision or action, this is called an appeal. The 60 calendar day period begins on the day after the mailing date on the letter.

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