Claims
What is the filing timeframe for providers to submit claims?
90 days
What is the minimum information to report a member's bill?
Provider's name and phone number
What tool is used to check into covered medical and dental services for our members?
Benefit Grid
What is the Adult Rewards Program called?
What about the rewards program name that is offered to our children members?
Adult rewards is called MyHealth Rewards
For the children, it is called MyKids Rewards
List two enchanced/supplemental benefits that caresource offers to IN Medicaid Members
(50 points each)
ANY 2 OF THE FOLLOWING;
Life Services
Express Banking
Community Resources
Re-Entry Program
Driver's License Reinstatement
Mom and Baby
Infant Home Scales
Healthy Baby Beginnings at Home (HBAH)
NICU Transportation
How long does it take caresource to process claims once they are received?
30 Days
How long does it take caresource to resolve a member's billing issue once it's reported?
30 Days
What is the name of the program that is a coordinated program conducted by health care professionals to assist members with specific health conditions to understand their condition and live successfully with it.
Care Management Program
How do members earn rewards if they are enrolled into MyHealth or MyKids rewards
By going to their dr appts or completing online education/activities
True or False?
The Re-Entry program is for adults who were released from jail/prison only.
False, its for adults AND children who were released from jail/prison.
What are the 3 pieces needed to research a medical or dental claim for a member?
If a member is reporting a bill from a collection agency, what would the member need to do once the bill is reported through member services?
They need to contact the collection agency to give them permission to speak with CareSource.
What benefit do we offer our member's who are trying to stop smoking?
Tobacco/Smoking Cessation
How long does it take rewards to be loaded towards a members account?
60 days once claim is received confirming a wellness actitity was completed
What type of people does the Mom and Baby Beginning (MBB) Program Team consist of?
MBB Team has nurses, social workers, behavioral health and lactation specialists
What systems are used to view medical, dental and vision claims?
Medical claims are stored in D365
Dental claims are stored in Skygen
Vision claims are stored with Eyemed
What does the member NEED to have in order for them to report a bill through member services?
Member must have a complete copy of the bill on hand. Either a physical copy of the bill or a digital image is acceptable.
How many medical transportation trips do our members have?
What about food trips?
Unlimited medical trips
5 food trips per month
How do we assist members who are stating they are missing rewards?
How long does it take caresource to get a resolution for missing reward issues?
Submit a ticket for members missing rewards
Caresource can take up to 30 days to get resolution for missing rewards
What is the max amount of money a member can qualify for to pay towards their driver's license reinstatement fines and fees?
$500 max per lifetime
What does the claim status "99" mean for a medical claim?
The claim was sent back to the provider for corrections.
If the member is reporting more than one bill, can we report the bills under one case?
Yes, ONLY if bills are from same provider/group (Tax IDs are the same first 9 digits) and share the same billing phone number.
What behavioral health services will require a prior auth?
Inpatient Behavioral Health (BH) and Substance Use Disorder (SUD) services require prior authorization.
How long do members have to access their myhealth and mykids rewards once their coverage with caresource has been termed?
MyHealth has 7 business days to access rewards
MyKids have one full year to use any remainder rewards
Who is the free infant scale program managed by?
NICU Care Manager