Marlien · Payer guide
CareSource of Georgia
CareSource of Georgia, Inc.
- GA
- Georgia Medicaid (Georgia Families / 360)
- Marketplace
- Medicare Advantage
Where you file
- How you apply
- GAMMIS (Medicaid, via the DCH Centralized CVO) + CareSource New Health Partner Contract Form
- The path
- Medicaid: enroll in Georgia Medicaid via GAMMIS, then CareSource contracting. Marketplace / MA: CAQH + CareSource's own committee.
- What access you need
- Provider Services 1-855-202-1058 · DXC Provider Relations (Medicaid) 1-800-766-4456
- Who verifies
- Georgia DCH Centralized CVO — CareSource does NOT credential internally for Medicaid
- Worth knowing
- The CVO's decision is provided to the CMOs. CareSource then sends the contract electronically on the CVO's completion notice. The Welcome Letter carrying the CareSource ID number is the completion signal.
CAQH
- Required
- ORDERING RULE: in CAQH, select the Authorization tab and confirm CareSource is listed BEFORE you submit your CAQH number. CareSource is a CAQH participating organization.
- Authorise this payer
- CareSource
Lines of business
Each line is its own application, with its own checklist, its own effective date and its own contract. Filing one does not file the others. What follows is what this payer asks for, line by line.
Georgia Medicaid (Georgia Families / 360)
The DCH Centralized CVO verifies and decides — CareSource does not credential internally. Your Welcome Letter with the CareSource ID number is the completion marker.
Marketplace
CareSource's own Credentialing Committee. You are informed within 60 business days of the committee meeting and considered recredentialed unless otherwise notified.
Medicare Advantage (MA)Medicare Advantage
CareSource's own committee, same clock as Marketplace. Backdating under 42 CFR 424.521 may apply.
What the payer publishes about time
- Completeness review
- CareSource answers status inquiries within 3 business days; the provider has 5 business days to answer a missing-information request
- Decision
- Medicaid: DCH CVO decision within 45 calendar days for a complete application. Marketplace / MA: informed within 60 business days of the committee meeting.
- Committee
- DCH CVO Credentialing Committee (Medicaid) · CareSource's own committee (Marketplace / MA)
- Contract
- sent electronically on the CVO's completion notice
- What the numbers mean
- CareSource's own committee reconfirms a Marketplace / MA provider as recredentialed unless otherwise notified — silence is approval there.
Deadlines that start a clock
Respond to a missing-information request — no response means discontinuance on day six5 business days
counted from the date we received the deficiency notice
File a written appeal — received by CareSource within 30 calendar days of notification of the reconsideration decision30 calendar days
counted from the payer's decision
CVO notifies at least 90 days before the re-credentialing due date90 calendar days
Status inquiry — CareSource is obliged to answer within 3 business days3 business days
counted from the date we submitted
Recredentialing
- Cycle
- 36 months
- What it hangs on
- NCQA / CVO cycle
- Worth knowing
- The CVO notifies providers at least 90 days in advance. If CareSource cannot confirm successful re-credentialing by end of business on the LAST DAY of the due month, the provider is either de-credentialed and removed from the panel, or must repeat credentialing from the beginning.
The effective date
Approval is not the date. These are the markers that make a date real.
- How it is established
- Medicaid: contract sent electronically on the CVO's completion notice; the Welcome Letter carrying the CareSource ID number marks the end of contracting and credentialing. Marketplace / MA: committee decision, then considered recredentialed unless notified otherwise.
- What proves it
- CareSource Welcome Letter with the CareSource ID number
- Worth knowing
- The Welcome Letter — not the committee decision — is the artifact that proves you are live. Do not record an effective date from a decision notice alone.
Backdating: 30 days
42 CFR 424.521(a)(1) — retrospective billing is permitted for up to 30 days before the effective date ONLY where circumstances precluded enrollment in advance of providing services, and only for services provided at the ENROLLED PRACTICE LOCATION. 90 days is available where a Presidentially-declared Stafford Act disaster precluded advance enrollment. It is a DETERMINATION, not an entitlement.
Federal rule, not confirmed in CareSource's own material. Medicare Advantage line only. Medicaid and Marketplace: no backdating authority identified.
This is a federal rule. This payer's own material does not confirm it, so we do not promise it. We tell the payer what the circumstances were and let the payer decide.
What we checked, and what we did not
GAMMIS prerequisite, New Health Partner Contract Form, CAQH authorization ordering, required document set, CVO vs internal committee split, 60-business-day Marketplace notice, 5-business-day response, 30-day appeal, 36-month cycle, D-SNP contracting path and all five links confirmed 2026-11-02.
The payer's own pages
Where to file
- New Health Partner Contract Form — Georgia Pathways (Medicaid / Marketplace)CareSource GA › Providers › Become a Participating Provider › PathwaysContracting for both Medicaid and Marketplace? Add BOTH plans to the same submission. Review the Becoming a Health Partner step-by-step guide before filling it in.
- New Health Partner Contract Form — Georgia D-SNP (Medicare)CareSource GA › Providers › Become a Participating Provider › Dual Special NeedsCareSource is an HMO D-SNP with a Medicare and a state Medicaid contract. Enrollment in CareSource depends on contract renewal.
- Georgia Medicaid enrollment — GAMMIS (DCH Enrollment Broker)Georgia Medicaid Management Information System — required BEFORE CMO participationMedicaid line only. CareSource will not credential a Medicaid provider without this.
- CAQH / DataSpring — authorize CareSourceProView › Authorization tab › confirm CareSource is listed, THEN submit your CAQH numberThe ordering rule is the whole trap: authorize first, submit the number second.
Information and forms
- Georgia DBHDD — Become a Provider (Community Behavioral Health)Georgia Medicaid behavioural health has its OWN state enrolment, separate from GAMMIS and from the health-plan contract: a New Provider Enrollment Forum, a Letter of Intent during an open enrollment period, an application, and a site visit if one is required. The Georgia Collaborative (Carelon) is the ASO that runs it for DBHDD. Credentialing and enrollment questions go to GACollaborative@carelon.com; documents go to GAEnrollment@carelon.com.
- Forms — Georgia Pathways (Medicaid / Marketplace)Includes the Provider Attestation Form, CCVS Provider Authorization and Release Form, Organizational Credentialing Application, HCBS Credentialing Application, Debarment Form and the CareSource Common Roster Template.
- Forms — Georgia D-SNP (Medicare)
- Georgia DCH — Centralized CVOThe NCQA-certified CVO that actually decides Georgia Medicaid credentialing.
- Georgia Medicaid managed care
Who to contact
- CareSource Provider Services (Georgia)Credentialing questions, application status, missing documents1-855-202-1058Voicemail is returned within three business days.
- CareSource Provider Services (D-SNP)Dual Special Needs contracting and credentialing1-833-230-2176
- DXC Provider RelationsMedicaid (Georgia) provider support1-800-766-4456
- Georgia DCH Centralized CVOMedicaid credentialing decisions