Working with IHCP Provider CareSource Workshop,...
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Working with CareSource IHCP Provider Workshop, Quarter 2
Transcript of Working with IHCP Provider CareSource Workshop,...
Working with CareSource
I H C P P r o v i d e r W o r k s h o p , Q u a r t e r 2
Agenda
Online New Health Partner Contract Form
Credentialing Process
Provider Portal
Health Partner Resources____________
Contacting CareSource
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Online New Health Partner Contract FormH i e r a r c h y F o r m i n s t r u c t i o n s
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Online New Health Partner Contract FormAt CareSource, we streamline our business practices to make it easy for you to partner with us.Our online New Health Partner Contract Form allows you to conveniently initiate the contracting process, as well as attach supporting documentation.
Benefits• Enhanced processing and response times• Quickly identify missing information from your
application• We send notifications directly to the individual
submitting the form so that missing information can be resolved quickly
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How to Access the New Health Partner Contract FormFollow these simple steps to access the New Health Partner Contract Form:1. Visit CareSource.com.2. Click on Providers (located on the top horizontal navigation
bar).3. Select Indiana from the menu.4. Select Medicaid from the menu.5. Select Plan Participation from the menu.6. Click on the New Health Partner Contract Form under the
“Become a Health Partner” heading.
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How to Fill Out New Health Partner Contract FormTab 1: InstructionsContains detailed information about how to start the process and how to use each of the next sections for completing the form.
Helpful Hint:Fields marked with a redasterisk are required.
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Tab 2: General Information• Collects information about group, contact information and
products.• CareSource product lines can be selected or removed by
simply clicking Add or Remove. • Select from the options provided in the drop down menu. You
need to select each product for which you want to participate.
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Helpful Hint:You may choose which CareSource products to participate in.
Add new products
Tab 2: General Information (cont.)• Once information is entered into the Remit Address section, the information can
automatically populate the Mailing Address and Contractual Updates Address sections.
• Simply check the Mailing Same as Remit Address and Contractual Updates Same as Remit Address boxes.
Helpful Hint:Addresses provided must match the addresses in CoreMMIS
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Copy the information provided in Remit address
Tab 3: Provider(s) • User may enter any number of health partners associated with
the submission.• At least one health partner must be entered. • Each health partner will be entered into a separate data record.• We will need a common address to complete the health
partner’s information as a master address.
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Tab 3: Provider(s), continued• The Add button in the right low corner allows addition of another
health partner. • Alternatively, the record can also be removed by simply clicking
the Remove button.
Copy the information provided in Common Address
Remove the data record for this provider
Tab 4: Submission • Helps validate the information.• Clicking Submitter Same As Office Contact copies address from
the General Information tab.• To save information and complete the form later, click the Request
additional time box and then Save (the save button appears after you click the Request additional time box). An email notice will remind you to complete the form.
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Copy the Address provided in General Information
Allows you to submit the form in an incomplete status to
complete at a later date/time.
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Tab 4: Submission, continued • Attach NOW – W9 and Supporting Documents allows you to attach
documentation to support the processing of the form. • By checking Ready for submission checkbox, the Submit button will display.
The Submit button will only appear if all required information has been entered on all tabs.
• Click on Submit to complete the process and submit the form.
Allows attachment of documents
Allows additional supporting documents
Allows submission of the form
After Submission• After submitting the form, the system will inform
the submitter, via email, that the New Health Partner Contracting form has been submitted successfully. The email will provide an application number.
• If your submission requires clarification or additional information, you will receive an email notification or a Credentialing Coordinator will contact you.
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Credentialing with CareSource
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Credentialing with CareSource –Credentialing as an OrganizationWe credential the following organizational provider types:• Hospitals• Home health agencies• Skilled nursing facilities• Free-standing ambulatory surgery
centers• Behavioral health facilities providing
mental health or substance abuse services in an inpatient, residential or ambulatory setting
We also credential:• Hospice facilities• Urgent care facilities, free-
standing and not part of a hospital campus
• Dialysis centers• Physical therapy , occupational
therapy and speech language pathology (PT/OT/SLP) facilities
We currently utilize the following Credentials Verification Organization (CVOs): McKesson and Credentialing Corporation of America (CCA).
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CareSource is a participating organization with the Council for Affordable Quality Healthcare (CAQH).1. Log on to the CAQH website at www.CAQH.org utilizing your account
information.2. Select the Authorization Tab.3. Make sure CareSource is listed as an authorized health plan.4. If not, please check the Authorized box to add.
Credentialing with CareSource –Credentialing as an Provider Group/Practitioner
Please submit a complete CAQH application or CAQH number and national provider identifier (NPI) number via one of three vehicles:
Email: [email protected]: 866-573-0018Mail: Send by certified mail with return receipt to:
CareSourceAttn: Contract ImplementP.O. Box 8737Dayton, OH 45401-8738
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Provider Groups/Practitioners That Do Not Require CredentialingPractitioners who practice exclusively within the inpatient setting and provide care to CareSource members only as a result of being directed to the hospital or other inpatient setting:
• Radiologists• Anesthesiologists• Pathologists• Hospitalists• Emergency Medicine
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Credentialing ProcessAfter you are credentialed with CareSource, you will receive a letter acknowledging your credentialing status.After all of your information is loaded into our database, you will receive a welcome letter from CareSource. It will include:
• The effective date of your contract• The programs you are participating in• Your CareSource Provider Billing Number
Please allow up to 30 days for completion of the onboarding process.Practitioners are considered out of network until they receive a welcome letter.
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CareSource Provider Portal FeaturesS a v e t i m e a n d m o n e y b y u s i n g t h e f e a t u r e s o n t h e s e c u r e C a r e S o u r c e P r o v i d e r P o r t a l
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CareSource Provider Portal Registration1. Go to CareSource.com. On the right side of the
page, click on Provider Portal under Provider Resources.
2. Select Indiana.3. Click register here under Register for the
Provider Portal.4. Enter your information, including your CareSource
Provider Number (located in your welcome letter).5. Follow remaining steps to register.
Helpful Hints:• The zip code is the practitioner’s primary location.• In order to utilize the CareSource Provider Portal,
you must use the Internet Explorer version 8, 9, 10 or 11 browser. We do not support Internet Explorer version 7. You may also use Google Chrome and Firefox browsers.
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How to Check Eligibility
Upon logging into the Provider Portal, health partners will be able to view member eligibility with:• 24 months of history• Member span information• Multiple member look-up (up to 500)
Select Member Eligibility on the left navigation under the Member Search menu.
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How to Check Claim Statuses
Claim status is updated daily on our Provider Portal, and you can check claims that were submitted for the previous 24 months. You can search by member ID number, member name and date of birth or claim number.Select Claim Information on the left navigation under the Member Search menu.
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Updating Information
Advance written notice of status changes, such as a change in address, phone or adding a health partner to your practice helps us keep our records current and are critical for claims processing.Select Provider Maintenance on the left navigation under the Providers menu.Note: Updates to information must also be made in CoreMMIS.
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Health Partner ResourcesC l a i m s f i l i n g i n f o r m a t i o n
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Health Partner ResourcesMedical and Dental Claims
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Provider Services 1-844-607-2831
Med Management Fax 844-432-8924
Website CareSource.com
Provider Portal https://providerportal.caresource.com/IN
Dental Provider Portal(Electronic Claim Submission) https://pwp.sciondental.com/PWP/Landing
Electronic Funds Transfer (EFT) InstaMed: 1-877-755-3392 (Note dental providers access through dental portal)
Electronic Claim Submission INCS1
Medical & Dental Claim Submission P.O. Box 3607Dayton, OH 45401-3607
Timely Filing 90 days from date of service or discharge
Contacting CareSourceW e a r e h e r e t o h e l p
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How to Reach Us
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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
[email protected], Health Partnerships
ENGAGEMENT SPECIALIST ASSIGNED COUNTIES / HEALTH SYSTEMS
MELISSA KAMEN | 317-509-2768
[email protected] Health, CMHCs and Associations
TONYA THOMPSON | 219-214-3950
[email protected]: Benton, Cass, Fulton, Jasper, Lake, LaPorte, Marshall, Newton, Porter, Pulaski, Starke, WhiteHealth Systems: Franciscan & Beacon Health Systems
SUSAN SCHURMAN | 574-253-7599
Counties: Adams, Allen, DeKalb, Elkhart, Huntington, Kosciusko, LaGrange, Miami, Noble, St. Joseph, Steuben, Wabash, Wells, WhitleyHealth Systems: Parkview, Lutheran & SJRMC
TROY MCKINLEY | 765-425-5636
Counties: Bartholomew, Blackford, Decatur, Delaware, Fayette, Franklin, Grant, Henry, Jay, Madison, Randolph, Rush, Union, WayneHealth Systems: Community Health Network
TENISE HILL | 317-220-0861
[email protected]: Boone, Hamilton, Hendricks, Johnson, Marion, Hancock, Morgan, ShelbyHealth System: Suburban Health Organization
AMY WILLIAMS | 317-741-3347
Counties: Brown, Carroll, Clay, Clinton, Fountain, Howard, Monroe, Montgomery, Owen, Parke, Putnam, Tippecanoe, Tipton, Vermillion, Vigo, WarrenHealth System: American Health Network & Eskanazi Health
BRANDT SIDWELL | 317-508-4628
Counties: Daviess, Dubois, Gibson, Greene, Knox, Lawrence, Martin, Perry, Pike, Posey, Spencer, Sullivan, Vanderburgh, WarrickHealth System: Deaconess & St. Vincent Health
ANGELINA WARREN | 317-658-4904
Counties: Clark, Crawford, Dearborn, Floyd, Harrison, Jackson, Jefferson, Jennings, Ohio, Orange, Ripley, Scott, Switzerland, WashingtonHealth System: KentuckyOne & Norton Health
PAULA DRYE | 317-430-2076
[email protected] Dental
CONTRACTING MANAGERS – HOSPITALS / LARGE HEALTH SYSTEMS
JENNIFER RAY | 317-446-1437
KEISHA ZACKERY | 317-760-2609
Thank You!
IN-P-0219; Date Issued: 06/01/2017 Date Approved: 06/01/201729
