CareSource Customer Care: A Complete, Practical Guide

Who CareSource Serves and How Customer Care Is Organized

CareSource is a nonprofit managed care organization founded in 1989 in Dayton, Ohio. It serves more than 2 million members across multiple states through Medicaid, Health Insurance Marketplace (ACA), and Medicare Advantage plans. Because benefits and rules differ by product and by state, CareSource routes customer care by plan type (Medicaid, Marketplace, Medicare) and by the member’s state of residence.

Member Services is the front door for benefits, claims, ID cards, and help finding care. Standard Member Services hours are typically Monday–Friday, 8 a.m.–6 p.m. local time, with extended hours during open enrollment for Marketplace plans; exact hours vary by state and product and are printed on the back of the CareSource ID card. A 24/7 Nurse Advice Line is available to members for clinical questions and after-hours guidance. Providers have a dedicated support line and portal for authorizations, claims, and eligibility.

How to Contact CareSource Quickly

For the fastest help, use the phone number printed on the back of your CareSource ID card; numbers are specific to your plan and state. If you don’t have your card, go to caresource.com/contact to select your state and plan for the correct Member Services number. TTY users can dial 711 (Telecommunications Relay Service) to reach all CareSource phone lines. For non-urgent help, log in to the secure member portal at my.caresource.com to send a message, view benefits, replace an ID card, or check claim status.

The 24/7 Nurse Advice Line can help you decide where to get care and what to do next, especially after hours and on weekends. For emergencies, always call 911. For mental health or substance-use crises, call or text 988 (Suicide & Crisis Lifeline), available 24/7 at no cost. If you need in-language support, ask for an interpreter; CareSource provides free interpretation and auxiliary aids.

Mailing addresses for claims, prior authorizations, or appeals are listed on your Explanation of Benefits (EOB) or in plan documents; use the address on your notice to avoid delays. Corporate headquarters: CareSource Management Group, 230 N. Main St., Dayton, OH 45402. General information and plan materials are at caresource.com; member self-service is at my.caresource.com; provider resources are at providers.caresource.com.

• Use the plan- and state-specific phone number on your ID card (fastest routing).
• Log in at my.caresource.com to check benefits, PCP, claims/EOBs, and to send secure messages.
• Call the 24/7 Nurse Advice Line for after-hours care guidance; call 911 for emergencies.
• Request free interpreters or auxiliary aids; TTY users dial 711 to connect.
• Find up-to-date contact options at caresource.com/contact if your ID card isn’t handy.

What to Have Ready When You Call

Have your CareSource member ID number, your full name, date of birth, address on file, and a callback number. If calling about a dependent, you may be asked to verify your relationship or provide an authorization if the dependent is an adult.

For claims or billing issues, keep the claim number, date of service, provider name, billed amount, and any statements from the provider or facility. For pharmacy questions, have the drug name and strength, pharmacy name, and the prescription or prior authorization number (if any). For authorizations, have the ordering provider’s NPI, the CPT/HCPCS codes, the diagnosis code(s), and the planned date of service.

Common Requests and Exact Steps

Benefits and Eligibility Verification

To confirm eligibility and cost sharing (copays, coinsurance, deductibles), log in to my.caresource.com and open your Benefit Details or Summary of Benefits and Coverage. You can also call Member Services; the agent can verify your active coverage dates, primary care provider (PCP), and whether a service is covered and requires prior authorization.

If you have a Marketplace or Medicare plan, ask for specifics by place of service (office, outpatient hospital, telehealth) and by provider network tier. For Medicaid, most preventive services are covered at $0 copay; however, some services require prior authorization or medical necessity review. Request a reference number for any benefits call and note the date/time for your records.

Claims and EOB Issues

Check claim status in the portal under Claims/EOBs. If a claim was denied, compare the denial reason code on the EOB to your benefit documents. Common issues include missing prior authorization, out-of-network provider, coordination of benefits, or incorrect coding. If you’ve updated other insurance (Medicare or commercial), notify CareSource to prevent future COB denials.

If you disagree with a denial, you can request a reconsideration or file an appeal. Keep all documentation: provider invoices, medical records (if you have them), and any prior authorization numbers. Balance billing protection: Medicaid members generally cannot be balance billed for covered services by in-network providers; report improper billing to Member Services.

Prior Authorizations and Referrals

Many advanced imaging, certain outpatient procedures, durable medical equipment, and some specialty drugs require prior authorization. Your provider usually submits the request through the CareSource provider portal or via EDI/fax; members can call to check status. Standard determinations are typically made within 14 calendar days for Medicaid and within 15 calendar days for Marketplace/Medicare, with expedited decisions in 72 hours when clinically urgent.

If a decision is delayed beyond the standard timeframe, ask for an escalation and a status reference number. If an authorization is approved, verify the approval window (start/end dates), the approved CPT/HCPCS codes, and the servicing provider location to avoid rescheduling or claim denials.

Grievances and Appeals: Timelines That Matter

A grievance is a complaint about service quality or customer service; an appeal is a request to review a denial or reduction of coverage or payment. File grievances as soon as possible; plans typically resolve within 30–90 calendar days depending on the issue and product line. Appeals must be filed by the deadline on your Notice of Action or EOB—commonly within 60 days for Medicaid and within 180 days for Marketplace/Medicare, though the exact limit is stated on your notice.

Standard appeal decisions are generally issued within 30 calendar days (Medicaid) or 30–60 days (Marketplace/Medicare). You can request an expedited (72-hour) appeal if waiting could seriously jeopardize your health. Keep copies of your appeal letter, medical records, and any provider support. For Marketplace plans, if the internal appeal is upheld, you may request an external review by an independent review organization through your state’s Department of Insurance; instructions are included with your appeal decision.

Language, Accessibility, and Care Management

CareSource provides free language interpretation in more than 200 languages, large-print materials, Braille, and TTY/relay access (dial 711). Let the agent know your preferred language at the start of the call. You can also request auxiliary aids for hearing or vision impairments; there is no cost for these services.

Members with complex or chronic conditions can enroll in care management or disease management programs at no cost. Ask Member Services to connect you to care management for help coordinating specialists, medications, equipment, and social needs. Many Medicaid plans include non-emergency medical transportation (NEMT); schedule rides several days in advance through the transportation vendor listed on your ID card or by calling Member Services for your state-specific process.

For Providers: Getting Answers Faster

Use the CareSource provider portal (providers.caresource.com) or your clearinghouse to check eligibility, submit prior authorizations, and track claims. Having the member ID, DOB, and your NPI/TIN ready speeds up phone authentication. Many authorizations can be submitted electronically with clinical attachments, which reduces turnaround time and avoids rework.

For claim denials, review the remit (CARC/RARC codes), correct coding, and any missing attachments. Submit reconsiderations within the timeframe on your remit (often 120–180 days from the remit date). For urgent authorization needs, mark requests as expedited only when clinical criteria are met; misuse of expedited queues can delay processing for all cases.

• Check eligibility and benefits electronically before scheduling; confirm network status and PA needs.
• Include diagnosis, CPT/HCPCS, place of service, and supporting clinical notes with auth requests.
• Verify approved dates and codes on every authorization before performing the service.
• File claims promptly and cleanly; correct COB info to avoid preventable denials.
• Escalate delays by referencing the authorization or claim number and documenting each contact.

Key References and Addresses

Headquarters: CareSource Management Group, 230 N. Main St., Dayton, OH 45402. Website: caresource.com. Member portal: my.caresource.com. Provider resources: providers.caresource.com. State- and plan-specific phone numbers: caresource.com/contact (or the back of the ID card). TTY: 711. Emergencies: 911. Crisis support: 988 (Suicide & Crisis Lifeline, 24/7). Disaster Distress Helpline: 800-985-5990.

Always rely on the contact details printed on your ID card or on official plan notices for appeals, grievances, and claims mailing addresses—these are tailored to your product and state and ensure your request reaches the correct team without delay.