Caresource Update

CareSource Update Feb. 5, 2020

The OSCA has been working with Caresource on two outstanding issues experienced by our members. Caresource has identified the operational errors leading to these issues and has announced a resolution date.

  • Mycare denial of CMT (98940-1) codes – Resolution date 04/21/2020
  • Thoracic X-ray (72070) denial – Resolution date 04/07/2020

Caresource intends to scrub their claims for services that were correctly billed by the provider but denied due to the above errors. Those claims will automatically reprocess for payment by the above dates. If, 30 days following the above dates, you still have claims that have not been re-processed for payment, you should reach out to the OSCA or Caresource at that time.  

You are not required to do anything else at this time, however, if you would like to reach out to Caresource between now and the resolution date regarding denials of the codes above, you can use the dispute and appeal process provided by Caresource. 

 
Update:  February 7, 2019

CareSource Take Backs:
  • Acupuncture – the acupuncture take back has been discontinued. If you received a request for refund of monies paid for acupuncture services, you can disregard the request.
  • X-ray – X-ray limitations for CareSource are 2 units per 6 months. If additional units are medically necessary, you can request a prior authorization for additional units. If you exceeded the benefit limit, you may receive a take back request for any units OVER the 2 unit per 6-month limit. If your office exceeded the allotted units, but feel the x-ray was medically necessary, you have the option to appeal the re-coupment and request a retro prior authorization for the service that exceeds the benefit limit. You must do this within 90 days of your notification. The policy can be viewed here.  Please note that their policy allows for 30 days from date of service to do a retro prior authorization under normal circumstances. However, if CareSource is initiating the take-back, you have 90 days from the date of the take-back notification to appeal and file a retro prior authorization request.  
 
CareSource Acupuncture Denials: CareSource is expected to update their their diagnosis list for acupuncture services in the next few weeks. The OSCA will forward that list on to membership as soon as it is received. Unresolved configuration issues that led to denials of acupuncture services in 2018 that should have been paid are being resolved. Those claims are expected to reprocess for payment toward the end of this month. This is limited to acupuncture services for migraine and low back conditions only.

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