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The Provider Portal makes it easier for you to work with us 24/7. It has critical information and tools to save your practice time.

Member & Eligibility Search
Claims Search, EOP & Submissions
Prior Authorization Search & Submissions
PCP Roster & Clinical Practice Registry

Forgot password?

Portal Registration Instructions

Check Enrollment Status

MESSAGES

Completing a Well Visit During a Sick Visit

Did you know that CareSource pays for a well visit to be completed on the same day as a sick visit? The well visit and sick visit will both be paid at 100% with the addition of a modifier 25. Children will often only visit their provider when sick. Caregivers may experience barriers to scheduling a well visit such as being unable to miss work. Completing the well visit during the sick visit may be the only opportunity the provider has to complete a well visit during the year and give any immunizations the child needs. Payment for a combination of certain services on the same day including: sick visits, well visits, immunizations, labs (including lead) is supported. How to bill when a patient is seen in the office for a well visit as a new or established patient, providers can bill that diagnostic exam as an E&M-25. Providers should reference the most up-to-date sources of professional coding guidance for valid Current Procedural Terminology (CPT)/Healthcare Common Procedure Coding System (HCPCS) codes.

Quality Patient Experience Guide

CareSource is working with providers to build a positive health care experience for patients.

CareSource wants to put our best foot forward when it comes to partnering with our providers. That’s why we created the Quality Patient Experience Guide. The guide outlines 7 ways we can fulfill our joint commitment to delivering a positive experience.

This resource covers the topics addressed in annual satisfaction surveys such as the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) and Qualified Health Plan Enrollee Experience (QHPEE) surveys. We hope you find it to be a helpful guide for programs and services that support you and your CareSource patients.
Go to Georgia Provider Quick Reference Materials > Quality Patient Experience Guide to learn more. We appreciate all that you do to provide quality care!

Marketplace Providers: Telehealth HEDIS Measure Quick Reference Guide is Available!

The landscape of telehealth has quickly evolved over the past year. Recent policy changes have expanded the use of telehealth to deliver acute, chronic, primary and specialty care to preserve and support the patient-provider relationship.

CareSource has developed the Telehealth HEDIS^® Measure Quick Reference Guide to provide guidance for activities where telehealth visits, and their related claims, may contribute to measurable quality outcomes in HEDIS^® (Healthcare Effectiveness Data and Information Set). This list is not inclusive of every health care service with a telehealth component.

Questions? Go to https://www.caresource.com/providers/contact-us/

Update Your Information

Effective Aug. 26, 2019, the Georgia Department of Community Health (DCH) is requiring all demographic changes for Georgia Medicaid providers be made through the GA Medicaid Management Information System (GAMMIS). CareSource will no longer accept demographic changes from health partners after this date.

If you a part of a health system that has a delegated credentialing arrangement with CareSource, you will continue to submit demographic changes as you currently do through roster submissions to the health plan.

Please contact our Provider Services team for more information.

Network Notifications

Stay informed with updates that impact claims, clinical guidelines, Provider Portal functions and more. Visit our Updates & Announcements page.

Registration

To register on the Provider Portal, complete the following steps:

Click the Register Here link in red at the top of the Login page.
On the User Registration page, complete the required information, and then click Next. Required fields are marked with a red asterisk.
- If you are registering as a provider, select Practitioner and complete the information.
  - All your information must match exactly as listed on your Explanation of Benefit (EOB) or welcome letter from CareSource.
  - For your ZIP code, if you have multiple addresses in your profile, any ZIP code from the profile will work.
- If you are registering as part of a provider group, select Group and complete the information.
  - When you register as a Group, you will have access to all information for all providers listed under the Group Tax ID.
  - Your Group Name, Tax ID, Provider ID and ZIP Code must match exactly as listed on your Explanation of Benefit (EOB) or welcome letter from CareSource.
- Tip – if you are unsure whether you should register as a Practitioner or Group, check your welcome letter from CareSource. If your welcome letter shows you registered under the Group Payee ID, then select Group as the provider type. If the welcome letter shows you registered as an individual, select Practitioner as the provider type.
Confirm the Provider Agreement, and then click Next.
To create your user account, do the following:
1. Type a User Name that you will use to log in.
2. Type a Password that you will use to log in. The password must meet the following requirements:
  - Must be a minimum of 12 characters
  - Must contain one lowercase letter, one uppercase letter, one digit and one non-alphanumeric character.
3. Type the email address that you want associated to your Provider Portal account. The email you enter is used to send your user account activation.
Select a Security Question, and type your Security Answer. Keep this information available, as you may need to answer your security question to confirm your identity when calling for support.
Click Finish Registration. You will receive a confirmation message at the email address you provided during the registration process.
Locate the email in your inbox to activate your Provider Portal account, open it, and then click the Activate Account link. The activation email will come from a sender titled webmaster and will have the subject Activate Your Provider Portal Account.
- If you do not see the activation email in your Inbox, do one of the following:
  - Check your spam folder.
  - Confirm that you have entered the email you registered with.
- If you get a message that you are already registered, go to the Provider Login page and log in.
- If you get a message that the provider does not exist in Provider Portal, you can call the help line at 1-855-202-1058 (Medicaid) or 1-833-230-2030 (Marketplace). This message may occur if the provider is not yet entered into our system (with the Tax ID or CareSource Provider Number you provided).
Locate and open the Email Verification message, and then click Login to access Provider Portal.

Password Reset/Locked Out of Account

If you are locked out of your account due to too many incorrect login attempts, or you do not remember your password, you can reset your password by following these steps:

Click the Forgot password? link on the login page.
Enter your Username, then click Submit.
Locate the email in your email inbox to reset your Provider Portal password. The reset password email will come from a sender titled webmaster and will have the subject CareSource Provider Portal Password.
1. If you do not see the email in your inbox, do one of the following:
  1. Check your spam folder.
  2. Confirm you are using the same email address that you registered with.

If your account is locked due to too many login attempts, use the Forgot password? link to reset your password, or you can wait 24 hours and attempt to log in again.