CareSource Provider Credentialing & Enrollment Guide

Did you know that CareSource serves more than 2 million individuals in 12 states across the US? It is a national, nonprofit managed care organization, i.e., dedicated to transforming health care for those served by government-sponsored health care programs. 

It offers different health insurance plans, including Medicaid, Dual Eligible Special Needs Plan, TRICARE Prime®, and Marketplace.

This guide will walk you through everything you need to know about the CareSource credentialing process, from requirements to challenges and best practices. So, continue reading!

A Step-by-Step Guide to CareSource Credentialing Application

Let’s review the steps involved to ensure successful CareSource insurance credentialing:

Step # 1: Initiate the Contracting Process

If you are a healthcare provider, then your first step should be to fill out the New Health Partner Contract Form.

Once the application is submitted, you will receive a confirmation email with your application ID.

You can use your application ID and National Provider Identifier (NPI) to check your CareSource credentialing application status on the Provider Portal.

Step # 2: Getting Credentialed with CareSource

Now that you have your application ID, you can complete your application with supporting documentation.

Also, note that CareSource is a participating organization with the Council for Affordable Quality Healthcare (CAQH). This means you must authorize CareSource access to your complete and attested CAQH ProView profile.

Here’s how you can do it:

• Sign in to your CAQH ProView profile.
• Select the ‘Authorization’ tab.
• Ensure CareSource Management Group is in your authorized health plans.
• If not, check the Authorized box to add it.

Also, make sure that your profile has all current documents and active licenses to prevent application stalls.

If any document is expired or missing, the CareSource insurance credentialing staff will issue a letter with instructions to correct and submit the updated information.

Step # 3: CareSource Provider Enrollment

Remember that you become eligible to submit medical claims to CareSource only after you are successfully enrolled with the carrier.

For context, it is the process of loading your credentials into all Managed Care Entities (MCE) internal systems.

That is, once enrollment is complete, your provider information has been added to the CareSource system and Provider Directory. Additionally, you will receive a ‘Welcome Letter’ within five business days.

This letter typically contains the following information:

• Participation effective date
• Enrolled products
• CareSource provider ID
• Additional instructions for claims submission
• Contact information

Disclaimer: You are required to be re-credentialed every 3 years.

CareSource Provider Credentialing Requirements

The table below offers an at-a-glance view of the key CareSource credentialing requirements:

Challenges in Getting Credentialed with CareSource

The following are some of the key barriers that may stall your CareSource credentialing application:

• The credentialing staff cannot access your CAQH profile because you forgot to authorize access to CareSource Management Group.
• Your CAQH profile lacks the following mandatory documentation:
  • Clinical Laboratory Improvement Amendments (CLIA) certificate (if applicable).
  • Collaborative practice agreement (if applicable).
  • Drug Enforcement Administration (DEA) certificate.
  • Malpractice insurance fact sheet
• Your CAQH profile contains expired licenses or is not up to date.

Best Practices for CareSource Insurance Credentialing

Credentialing itself is a lengthy procedure and typically takes up to 90 days. The challenges we discussed in the previous section can further delay your enrollment. 

But there is good news! With the following best practices, you can bypass potential delays and expedite the credentialing with CareSource:

• Maintain an active and attested CAQH ProView profile.
• Do not forget to authorize access to CareSource Management Group.
• Always complete your state Medicaid registrations before submitting the credentialing application.
• Cross-check your CAQH profile, IRS documentation, and the CareSource credentialing forms to ensure they have the same practice name, TIN, NPI, and billing address.
• Provide a resume in MM/YY format and explain any practice gaps that may exceed 30 to 60 days.
• Ensure that your CAQH profile contains active licenses, DEA certificates, and malpractice face sheets.
• Closely monitor application status through the provider portal.
• Update and re-attest your CAQH ProView profile every 120 days.

Pro Tip: If you do not have the budget to hire a credentialing expert in-house, get CareSource insurance credentialing services from professionals at MediBillMD.

Fast-Track CareSource Credentialing With MediBillMD

With that said, it is time to conclude. Remember that if you want to become an in-network provider with CareSource, then you must first contract with it by filling out the Health Partner Contract Form.

Once done, you have the application ID. Now you can log in to the Provider Portal and complete the credentialing process.

Upon successful completion of CareSource credentialing, it loads your details into the internal system and Provider Directory. 

However, if you still struggle, feel free to schedule a call with our representative to discuss your outsourcing options.