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The document is a CareSource Provider/Group Change Request Form used to request changes related to healthcare providers within a participating group. It includes options to add or delete providers, update demographic information, and specify product types such as Medicaid and SNP. The form requires detailed provider information and contact details, along with instructions for submission.

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

How do I correct a medical claim?

Resubmit a Claim. When you need to resubmit a claim, file an appeal, or send a corrected claim, use the Billing History in the patients chart to add claim resubmission information to the encounter and queue up a new claim. In the patients Billing History, select the encounter that may need a new claim.

What is the submission code for a corrected claim?

Corrected Claim Submission: EDI Claims Corrections can be sent in an electronic format. On the CMS-1500 Form, use Corrected Claim Indicator (Medicaid Resubmission Code). Enter the frequency code 7 in the Code field and the original claim number in the Original Ref No. field.

How do I submit a corrected claim on ub04?

Use red drop on UB-04 paper forms only. Replacement/corrected claims require a Type of Bill with a Frequency Code 7 (field 4) and claim number in the Document Control Number (field 64). Enter all required data. All patient details are required (ID number with prefix, last name, first name, and date of birth).

What is the PO box for CareSource in Ohio?

CareSource Attn: Claims Department P.O. Box 8730 Dayton, OH 45401-8730 Timely Filing: 365 calendar days from the date of service or discharge CareSource encourages providers to submit claims electronically for the most efficient processing.

What is the phone number for CareSource for providers?

Use the HAP CareSource provider portal or call Provider Services at 1-833-230-2102.

How do I submit a corrected claim to CareSource?

Corrected claims should be sent to: CareSource Claims Dept., P.O. Box 3607, Dayton, OH 45401-3607.

Does CareSource accept corrected claims?

For faster processing and payment, you can submit corrected claims electronically. CareSource accepts electronically submitted, corrected Professional EDI 837P 005010X222A1 (CMS-1500 equivalent) and 837I 005010X223A2 Facility (UB-04 equivalent) claims.

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