Member Reimbursem*nt Form Ohio Caresource (2024)

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Member Reimbursem*nt Form Ohio Caresource (1)

Ach all prescription receipt(s) to the back of this form. 3. All receipts must contain all of the following information or they will not be accepted: RX number, date lled, Pharmacy NPI#, drug name with NDC number, strength, quantity, days supply, and amount paid. 4. If you have any questions, please call Member Services: 1-800-708-8729 (TTY/TDD 1-800-750-0750) or 711. 5. The form should be signed by the member and mailed to: CVS Caremark Med D Claims P.O. Box 52066 Phoenix, AZ 85072-2066 Re.

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Member Reimbursem*nt Form Ohio Caresource (2)

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Reimbursem*nts FAQ

  • Buckeye Health Plan Rated Best Medicaid Health Plan for Quality Performance. The Ohio Department of Medicaid (ODM) awarded Buckeye Health Plan the highest quality rating among all Ohio managed care plans with 20 stars across the five categories on its 2018 Managed Care Plans Report Card published today.

  • Medicaid health care coverage is available for eligible Ohioans with low income, pregnant women, infants and children, older adults and individuals with disabilities. CareSource Medicaid is available across the state of Ohio. When you apply for Ohio Medicaid, you can choose CareSource as your managed care plan.

  • The following individuals may qualify for Medicaid coverage in Ohio: Be a United States citizen or meet Medicaid non-citizen requirements. Individuals with low-income. Pregnant women, infants, and children.

  • The Ohio Department of Medicaid (ODM) provides health care coverage to more than 3 million Ohioans through a network of more than 165,000 providers.

  • CareSource® MyCare Ohio is a Medicare-Medicaid plan that delivers extra benefits and the coordinated care needed by both patients and caregivers, giving patients more coverage and caregivers more options.

  • Providers may file a written claim dispute no later than 12 months from the date of service or 60 calendar days after the payment, denial or partial denial of a timely claim submission, which is later. Submitted complaints should include: The member's name, CareSource member ID number and date of birth.

  • 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.

  • EDI Clearinghouses Please provide the clearinghouse with the CareSource payer ID number: 38325.

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