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2021 Member Handbook Healthy Indiana Plan (HIP) Hoosier Healthwise (HHW) Caresource | 2021Provider Member Manual Handbook Caresource | 2021 Member Handbook

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2021 Member Handbook Healthy Indiana Plan (HIP) Hoosier Healthwise (HHW) Caresource | 2021Provider Member Manual Handbook Caresource | 2021 Member Handbook 2021 Member Handbook Healthy Indiana Plan (HIP) Hoosier Healthwise (HHW) CareSource | 2021Provider Member Manual Handbook CareSource | 2021 Member Handbook Welcome to CareSource We are excited to serve you! We serve Hoosier Healthwise (HHW) and Healthy Indiana Plan (HIP) members in Indiana. We know life is busy. We are here to make things easier to start your health journey with us. We believe you deserve more than high quality health care. You deserve to be covered with kindness. Please use this member handbook to: • See tools available to you, like CareSource.com and Member Services • Learn how and where to get care • See your covered benefits, services and rewards • Find pharmacy and medicine information • Understand your member rights and responsibilities and how we keep your information private When reading this handbook, you will find an icon (picture) next to certain information. The key (meanings) for the icons can be found below this paragraph. If you have questions, please feel free to call Member Services at 1-844-607-2829 (TTY 1-800-743-3333 or 711). ICON KEY Valuable information While reading this handbook, look for these icons. They will tell you how to Make note find information. Please highlight the information so that you can find it more Access online easily at a later time. Smartphone App Telephone If you have questions, please call Member Services at 1-844-607-2829 (TTY: 1-800-743-3333 or 711). For more information, visit CareSource.com i CareSource | 2021 Member Handbook Make the Most of Your Plan by Using These Tools Visit CareSource.com to: • Learn about services and how to get them • See the list of covered drugs • Use the Find a Doctor/Provider tool to find a health provider • Learn your rights and responsibilities • Access your secure member portal My CareSource® account Call Member Services for: • Information about your benefits and plan • Help finding a doctor or other health care provider • Help knowing pharmacy/drug benefits • Choosing a drug • Finding out what is covered or if you need prior authorization (PA) • Getting a copy of your ID card • Getting to your MyCareSource.com account Use the CareSource Mobile App to: • View your digital member ID card • Find a doctor, hospital, clinic or urgent care near you • View your claims • Pay your bill (HIP only) • Call and talk with Member Services • Call CareSource24® Nurse Advice Line to talk with a nurse 24/7/365 • Connect with MYidealDOCTOR®, your telemedicine provider Call the CareSource24 nurse advice line to: • Get help when you are sick • Find out how to care for an injury • Find out more about drugs or other medicines • Decide what kind of care you need • Get information about medical tests or surgery • Learn about healthy eating or wellness ii If you have questions, please call Member Services at 1-844-607-2829 (TTY: 1-800-743-3333 or 711). For more information, visit CareSource.com CareSource | 2021 Member Handbook How to Reach Us Member Services Phone: 1-844-607-2829 (TTY: 1-800-743-3333 or 711) Monday through Friday, 8 a.m. to 8 p.m. Eastern Time Mailing Address: 230 N. Main Street Dayton, Ohio, 45402 Online: CareSource.com. This is a private online account where you can chat with Member Services. CareSource24 Nurse Advice Line: 1-844-206-5947 (TTY: 1-800-743-3333 or 711) CareSource Transportation Services: 1-844-607-2829 (TTY: 1-800-743-3333 or 711) Hours of Operation: CareSource is open for business Monday – Friday, 8 a.m. to 5 p.m. CareSource is closed* on: • New Year’s Day - Friday, January 1, 2021 • Martin Luther King Jr. Day - Monday, January 18, 2021 • Memorial Day - Monday, May 31, 2021 • The day after Independence Day - Monday, July 5, 2021 • Labor Day - Monday, September 6, 2021 • Thanksgiving Day - Thursday, November 25, 2021 • The day after Thanksgiving Day - Friday, November 26, 2021 • The day before Christmas Eve - Thursday, December 23, 2021 • Christmas Eve - Friday, December 24, 2021 *Our CareSource24 Nurse Advice Line is open 24/7, 365 days a year, along with observed holidays. Accommodations Is There a CareSource Member in Your Family Who: • Does not speak English? • Has hearing or vision problems? • Has trouble reading or speaking English? If so, we can help. We can get you sign or other language interpreters. We can explain this information in English or in your primary language. Interpreters can help members talk with us or their health care provider. They can help you with a grievance or an appeal. A grievance or an appeal is when you are not happy with a decision. They can help over the phone or in person at a health care visit. You can also get this handbook for free in other formats. These formats include large print, braille, or audio. Call Member Services five business days before your doctor visit for a sign language interpreter. Call Member Services four business days before your visit for other language interpreters. You can get these services at no cost to you. Call Member Services toll free at 1-844-607-2829 (TTY: 1-800-743-3333 or 711) to arrange for interpreter services. We are open Monday through Friday, 8 a.m. to 8 p.m. Eastern Time. If you have questions, please call Member Services at 1-844-607-2829 (TTY: 1-800-743-3333 or 711). For more information, visit CareSource.com iii CareSource | 2021 Member Handbook YOU ARE NOT ALONE. Are you or someone you know in crisis? If you are thinking of hurting yourself or someone else, please ask for help. All calls are confidential. Suicide Prevention Hotline: 1-800-273-8255 Need Help with Addiction Issues? STRUGGLING WITH ADDICTION? There is help if you or a loved one has drug or alcohol addiction. Start your road to recovery today. CareSource Addiction Hotline: 1-833-OPIOIDS (674-6437) 1 If you have questions, please call Member Services at 1-844-607-2829 (TTY: 1-800-743-3333 or 711). For more information, visit CareSource.com CareSource | 2021 Member Handbook Table of Contents Welcome to CareSource ....................................... i Babies First® ...................................................26 Make the Most of Your Plan by Text4Baby .......................................................26 Using These Tools ................................................ ii Care Management ..............................................27 How to Reach Us .............................................iii Coordination of Care ......................................28 Quick Start Guide .................................................4 Right Choices Program (RCP) ........................28 Where to Get Care ................................................6 High Risk Care Management ..........................28 Your Primary Medical Provider (PMP) ..............6 Care Transitions: .............................................28 Where to Go for Care ...........................................7 CareSource Re-Entry ProgramTM ......................29 Doctor’s Office ..................................................7 Expungement .................................................29 ® MYidealDOCTOR ............................................7 Disease Management ........................................30 Convenience Care Clinic ..................................7 Medically Frail and HIP Benefits .....................30 Urgent Care ......................................................7 More than Health Care: Extra Incentives Emergency Room (ER) .....................................7 and Rewards .......................................................31 Follow-Up Care (also called Incentives and Rewards .................................31 Post-Stabilization Care) ....................................8 Babies First Rewards .....................................31 Unsure Where to Go? .......................................8 2021 Babies First Rewards ............................31 If you need the ER ............................................8 Kids First Rewards .........................................32 Mental Health and Addiction Services .............8 2021 Kids First Rewards ................................32 Therapies and Habilitative Services .................8 MyHealth Rewards for Adults .........................33 Member Benefits ................................................11 2021 MyHealth Rewards ................................33 In Network ......................................................11 CareSource Driver’s License Prior Authorization (PA) ...................................11 Reinstatement Benefit .......................................35 Services That Need a Referral ........................11 Infant scales ........................................................35 Services That Need a Referral and CareSource JobConnectTM ................................37 Prior Authorization (PA) ...................................12 myStrengthSM ......................................................37 Services Outside of Network ..........................12 Transportation Policy .........................................37 Continuity of Care ...........................................12 No Shows .......................................................38 Hoosier Healthwise (HHW) ................................13 Services Not Covered ........................................38 HHW Benefit Packages ..................................13 Pharmacy/Prescription Drugs ...........................39 HHW Benefit Summary ..................................13 Preferred Drug List (PDL) ................................39 Healthy Indiana Plan (HIP) .................................17 Step
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