CareSource Ohio
Welcome to the CareSource Ohio Health Plan page. The documents below have been designed to help RadMD users navigate the prior authorization process for each program Evolent (formerly National Imaging Associates, Inc.) is responsible for. Additional process-specific training tools and modules can be found via links on the Resources tab at the top of the screen.
If you have any questions about our programs, please contact your dedicated Evolent Provider Relations Manager, Mara Grimm.
CareSource Ohio (Medicaid)
Advanced Imaging Program
- Frequently Asked Questions
- Peer-to-Peer Process
- Provider Education Presentation
- Quick Reference Guide
- Utilization Review Matrix
For access to our Advanced Imaging tip sheets/checklists, click here.
CareSource Ohio (Medicare)
Advanced Imaging Program
- Frequently Asked Questions
- Peer-to-Peer Process
- Provider Education Presentation
- Quick Reference Guide
- Utilization Review Matrix
For access to our Advanced Imaging tip sheets/checklists, click here.
CareSource Marketplace Ohio (Exchange)
Advanced Imaging Program
- Frequently Asked Questions
- Peer-to-Peer Process
- Provider Education Presentation
- Quick Reference Guide
- Utilization Review Matrix
For access to our Advanced Imaging tip sheets/checklists, click here.
CareSource Marketplace Ohio (Exchange)
Cardiac Program
For access to our Cardiac tip sheets/checklists, click here.
Conservative Treatment Forms
For access to our conservative treatment forms, click here.
Clinical Guidelines
To request a specific 27th edition MCG Ambulatory Care guideline, please email medicalpolicyteam@evolent.com.In absence of MCG Guidelines®, CareSource Ohio uses the below Guidelines:
- MRI Low Field
- Spinal Canal MRA
- Unlisted Studies
- Cerebral Perfusion CT
- Follow up, Limited, or Localized CT
Evolent uses for Ohio Exchange members Evolent Clinical Guidelines.
Evolent uses for Ohio Medicare Members the (Local Coverage Determinations (LCD) and National Coverage Determinations (NCD) directly from CMS.
Refer to the Utilization Review Matrix document to view specific codes managed by Evolent.