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CareSource

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I H C P 2 0 1 7 A n n u a l S e m i n a r

Agenda

About CareSource

Member ID Cards &

Copayments

Working with CareSource

Covered Services

Resources

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About CareSource

H e a l t h C a r e W i t h H e a r t

About CareSource

OUR MISSION:To make a lasting difference in our members’ lives by transforming their health and well-being

OUR PLEDGE: Make it easier for you to work with us

Partner with providers to help members make healthy choices

Direct communication

Timely and low-hassle medical reviews

Accurate and efficient claims payment

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Health Care With Heart

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MISSION FOCUSEDComprehensive, member-centric health and life services

EXPERIENCEDWith over 27 years of service, CareSource is a leading non-profit health

insurance company

DEDICATEDWe serve over 1.8 million members through our Medicaid,

Marketplace, and Medicare Advantage Plans.

Provider Network

• Until further notice, Hoosier Healthwise and HIP will be operating as open networks.

• Any active Indiana Health Coverage Program (IHCP) provider may render covered services to a CareSource member.

• Please note that services requiring prior authorization apply to CareSource participating and non-participating providers.

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Provider Network

CareSource members choose or are assigned a primary medical provider (PMP)

upon enrollment. However, the PMP does NOT appear on the members ID card.

When referring patients, we strongly encourage other providers are in-network to

ensure coverage.

Use our Find A Doc tool at CareSource.com to help you locate a participating

CareSource provider by plan.

OUT OF NETWORK SERVICESUpon closure of our Hoosier Healthwise and HIP network, out-of-network services will

NOT be covered unless they are emergency services, self-referral services or prior

authorized by CareSource.

A provider must be enrolled as an IHCP provider to receive reimbursement for any

Medicaid services, including emergency and self-referral services.

A 45 day advance notice will be given prior to network closure.

Member ID Cards & Copayments

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Hoosier HealthwiseMember ID Cards

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HOOSIER HEALTHWISE HOOSIER HEALTHWISE + MATERNITY

HIP Member ID Cards

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HEALTHY INDIANA PLAN HIP MATERNITY

Basic Copayments

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Healthy Indiana Plan

Healthy Indiana Plan Basic & Healthy Indiana Plan State Plan Basic members are required to make the following copayments at the time services are rendered:

• $4 copayment for outpatient services, including office visits and preferred drugs

• $8 copayment for non-preferred drugs

• $8 copayment for initial non-emergent ER visit

• $25 for each subsequent non-emergency ER visit

• $75 copayment for inpatient service

Copayments at time of service for HIP Plus:

• $8 copayment for initial non-emergent ER visit

• $25 copayment for each subsequent non-emergent ER visit

NOTE: No copayment is required for preventive care, including early periodic screening, diagnostic and

testing services, or family planning services

Basic CopaymentsHoosier Healthwise

• Package C

• $3 copayment for generic, compound and sole-source prescriptions

• $8 copayment for initial non-emergent ER visit

• $10 copayment for emergency ambulance & non-emergent ambulance services

between medical facilities when requested by a participating physician

• $10 copayment for brand-name prescriptions

• $25 copayment for each subsequent non-emergent ER visit

• Package C copayment, for some services, is based on family income

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Working with CareSource

W e p a r t n e r t o m a k e d o i n g b u s i n e s s w i t h u s e a s i e r

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Claim Submissions

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ELECTRONIC DATA INTERCHANGE

CareSource currently accepts electronic claims through the clearinghouses listed below.

CLEARINGHOUSE WEBSITE PHONE

Availity (RealMed) www.availity.com 1-800-AVAILITY

Change Healthcare

(formerly Emdeon)

www.changehealthcare.com 1-800-845-6592

Quadax www.quadax.com 1-440-777-6305

Relay Health connectcenter.relayhealth.com 1-800-527-8133

NOTES• Please list your NPI number on all claims

• Please ensure you list the correct billing provider taxonomy code

• Please use member RID number

WE ENCOURAGE ELECTRONIC PAYMENTS

• Our Electronic Funds Transfer partner is InstaMed

• Health Partners must enroll with InstaMed to participate

• Find the enrollment form @ www.caresource.com and email it to

support@instamed.com

Online Claim SubmissionsProvider Portal

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Online Claim Submission continued

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1.

Select

New

Claim

4. Select

Create

2. Select

Provider 3. Select

Document

Type

Online Claim Submission (continued)

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Continue to complete each form and finish by clicking Submit.

Cultural Competency

Health partners are expected to provide services in a culturally competent manner, including:

• Removing all language barriers to service Accommodating unique cultural, ethnic, and social needs of members

• Meeting the requirements of all applicable state and federal laws

RESOURCESWe provide cultural competency training sources in the Health Partner Manual and online at CareSource.com.

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Contact our Health Partner

Services Department, at 1-844-

607-2831 to arrange for

interpreter services

PharmacyPARTNERSHIP WITH CVS

• CVS Caremark is the delegated pharmacy benefit manager for CareSource

• Phone: 1-800-364-6331

• Fax: 866-930-0019

SPECIALTY DRUGS• CVS Specialty Pharmacy provides all specialty medications

E-PRESCRIBING• Once providers are set up through CVS Caremark, they are ready to prescribe

electronically

RESOURCES• Authorization requirements for prescriptions may be found on your plan’s

Provider pages under the Pharmacy section.

• Formulary Search Tool and Prior Authorization lists are available on CareSource.com under Member Documents

• MTM (Medication Therapy Management) – allows pharmacists to work collaboratively with physicians

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Care and Disease Management

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WE CAN HELP:• Coordinate medications

• Provide education

• Arrange follow-up services

• Reduce readmission risks

PLEASE HELP by identifying

patients who may need individualized attention to help them manage their complex health care needs.

REFERRING A

PATIENTYou may refer a patient for care or

disease management in the following

ways:

CareSource.com through the

Provider Portal

1-844-607-2829

ONLINE

CALL

Covered Services

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HHW & HIP Benefits

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ENHANCED BENEFITS:

Life Services

Non-emergent transportation (additional above NET, for certain special populations)

HELP4U

Wellness & disease management

Smartphone referrals

Text4Babies

Medication therapy management

Boys & Girls Club membership (ages 6 –18) at no cost to the member

Girl Scout membership (grades K – 8) atno cost to the member

HHW & HIP BENEFITS OVERVIEW:

PCP and specialist office visits

ER services

Inpatient hospital

Mental health and substance abuse services

Urgent care

Family planning

Diagnostic services (ex: lab & radiology)

Preventative services (routine well visits and screenings)

Maternity services

Pharmacy

Transportatin

HOOSIER HEALTHWISE & HIP PLUS ONLY:

Vision services

Dental – no limitations on fillings or extractions (HIP PLUS only)

Services Not Covered

• Medically unnecessary services

• Services received from a non-network provider, unless the member has prior authorization or CareSource is operating as an open network

• Experimental or investigational services

• Alternative or complimentary medicine

• Cosmetic procedures or services

• Assisted reproductive therapy

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Resources

W e p a r t n e r w i t h r e s o u r c e s t h a t h e l p y o u n a v i g a t e t o t h e a n s w e r s y o u n e e d

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CareSource Provider Portal

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Check member eligibility and

benefit limits

Access the Provider Portal 24 hours a day, 7 days a week, at CareSource.com.

SAVE TIME. SAVE MONEY. Use CareSource’s secure online Provider

Portal.

With this tool you can:

Find prior authorization

requirements

Submit and check the status

of a prior authorization

request

Submit claims and verify

claim status

Verify or update Coordination

of Benefits information (COB)

And more!

Register for the CareSource Provider Portal

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Go to CareSource.com. On the right side of the page, click on Provider

Portal under Provider Resources

Select Indiana.

Click register here under Register for the Provider Portal.

Enter your information, including your CareSource Provider

Number (located in your welcome letter).

Follow remaining steps to register.

Health Partner Resources

Visit the CareSource.com Plan Resources page to access the following resources:

• Printable Health Partner Manual

• Printable orientation slides

• Formularies

• Covered benefits

• Quick reference guides

• And more

CareSource Provider Portal: https:providerportal.caresource.com/IN

CareSource.com/Providers

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Member Resources Page

Help your CareSource patients understand their insurance coverage.

Encourage them to visit our website, where they can access:

• Searchable online formulary

• Find a Doctor/Provider tool

• Member handbook

• Forms

• And more

CareSource.com/Members

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How to Reach Us

Provider Services 1-844-607-2831

Hours Monday to Friday

8 a.m. to 8 p.m. (EST)

Member Services 1-844-607-2829

Hours Monday to Friday

8 a.m. to 8 p.m. (EST)

Engagement Specialist

Assignments

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DENISE EDICK | 317-361-5872

denise.edick@caresource.comManager, Health Partnerships

ENGAGEMENT SPECIALIST ASSIGNED COUNTIES / HEALTH SYSTEMS

MELISSA KAMEN | 317-509-2768

melissa.kamen@caresource.comIU Health and Suburban Health Organization

TONYA THOMPSON | 219-214-3950

tonya.thompson2@caresource.com

Counties: Benton, Cass, Fulton, Jasper, Lake, LaPorte, Marshall, Newton, Porter, Pulaski, Starke, White

Health Systems: Franciscan & Beacon Health Systems

SUSAN SCHURMAN | 574-253-7599

susan.schurman@caresource.com

Counties: Adams, Allen, DeKalb, Elkhart, Huntington, Kosciusko, LaGrange, Miami, Noble, St. Joseph,

Steuben, Wabash, Wells, Whitley

Health Systems: Parkview, Lutheran & SJRMC

TROY MCKINLEY | 765-425-5636

troy.mckinley@caresource.com

Counties: Bartholomew, Blackford, Decatur, Delaware, Fayette, Franklin, Grant, Henry, Jay, Madison,

Randolph, Rush, Union, Wayne

Health Systems: Community Health Network

PAULA DRYE | 317-430-2076

paula.drye@caresource.com Counties: Boone, Hamilton, Hendricks, Johnson, Marion, Hancock, Morgan and Shelby

AMY WILLIAMS | 317-741-3347

amy.williams@caresource.com

Counties: Brown, Carroll, Clay, Clinton, Fountain, Howard, Monroe, Montgomery, Owen, Parke, Putnam,

Tippecanoe, Tipton, Vermillion, Vigo, Warren

Health System: American Health Network & Eskanazi Health

BONNIE WAELDE | 812-454-5832

bonnie.waelde@caresource.com

Counties: Daviess, Dubois, Gibson, Greene, Knox, Lawrence, Martin, Perry, Pike, Posey, Spencer, Sullivan,

Vanderburgh, Warrick

Health System: Deaconess & St. Vincent Health

VACANT Counties: Clark, Crawford, Dearborn, Floyd, Harrison, Jackson, Jefferson, Jennings, Ohio, Orange, Ripley,

Scott, Switzerland, Washington

Health System: KentuckyOne & Norton Health

ANGELINA WARREN | 317-658-4904

angelina.warren@caresource.comStatewide Behavioral Health

CONTRACTING MANAGERS – HOSPITALS / LARGE HEALTH SYSTEMS

MANDY BRATTON | 317-209-4404

mandy.bratton@caresource.comTENISE HILL | 317-220-0861

tenise.hill@caresource.com

Partners with Purpose

Are you contracted with all our plans? Join us on the next journey to healthy outcomes in Indiana.

Visit CareSource.com/Contracting to start the contracting process.

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Thank You!

IN-P-0276; Date Issued: 10/17/17 Date Approved: 9/20/1732