How To Submit Claims To CareSource

For CareSource, the practical claims workflow usually starts with electronic submission guidance and only falls back to paper instructions when the payer documents a mailing address for specific claim types or exceptions. The details below keep the workflow broad instead of reducing it to a single address.

At a glance

• CareSource Nevada Medicaid accepts both electronic and paper claims. The preferred route is online submission through the Provider Portal; the provider manual also lists EDI through Availity, with payer ID NVCS1. Paper claims must use current CMS/NUCC forms and cannot be handwritten or submitted as superbills. Corrected claims require the original claim number and must be coded as replacements.

Submission channels

• Provider Portal
• EDI through Availity
• Paper claim forms

Electronic claims payer IDs

• NVCS1

Paper claims addresses

• CareSource Attn: Claims Department, P.O. Box 3607, Dayton, OH 45401

Corrected claims and follow-up

• Include the original CareSource claim number on corrected claims

• EDI corrected claims should use CLM05-3 value '7' (Replacement) and REF02 qualifier 'F8' with the original reference/claim number

• Professional paper corrected claims: put '7' in the left-hand side of Box 22 and the original claim number in the right-hand side

• Institutional paper corrected claims: put the original claim number in Box 64 and a valid bill frequency code in Box 4

• If a corrected claim is submitted without the required information, it may be processed as an original claim and rejected or denied as a duplicate

• Claims status resource 1

• Claims status resource 2

Caveats

• The Nevada Medicaid provider manual and Nevada claims page should be used together because the page is high-level while the manual contains operational detail.
• The manual says portal submission is available to traditional providers, community partners, delegates and health homes.
• Paper claim processing rules require the current CMS/NUBC/NUCC form versions.

Provider resources

• Nevada Medicaid Provider Manual (PDF) (official)
• Nevada Medicaid Provider Claims page (official)
• Nevada Medicaid Prior Authorization page (official)
• Nevada Medicaid Provider Contact Us (official)
• Nevada Medicaid Provider Disputes or Appeals (official)

Sources