CareSource policy updates
Track new and updated CareSource policies impacting reimbursement and clinical operations.
| Policy | Payer | Type | Specialty | Change | Effective |
|---|---|---|---|---|---|
| Airway Clearance Devices | CareSource | Clinical | Pulmonology | Modified | Aug 1, 2026 |
| Behavioral Health Service Record Documentation Standards | CareSource | Administrative | Psychiatry/Behavioral Health | Modified | Jul 1, 2026 |
| Cystic Fibrosis Testing | CareSource | Administrative | Genetic & Molecular Testing | Modified | Jul 1, 2026 |
| Medical Benefit Drugs administrative policy | CareSource | Administrative | Pharmacy & Specialty Drugs | Modified | Jul 1, 2026 |
| Relatives or Guardians as Paid Providers | CareSource | Administrative | Post-Acute & Facility Care | Modified | Jul 1, 2026 |
| Telemedicine Services | CareSource | Administrative | Telehealth & Remote Monitoring | Modified | Jul 1, 2026 |
| Private Duty Nursing (PDN) | CareSource | Clinical | Home Health & Hospice | Modified | Jul 1, 2026 |
| Adzynma (ADAMTS13, recombinant-krhn) — Medical prior authorization and coverage criteria for congenital TTP | CareSource | Clinical | Pharmacy & Specialty Drugs | Modified | Jul 1, 2026 |
| Negative Pressure Wound Therapy (NPWT) | CareSource | Clinical | Wound Care | Modified | Jul 1, 2026 |
| Use of Modifier 59 and X{EPSU} (XE, XP, XS, XU) | CareSource | Reimbursement | Other | Modified | Jul 1, 2026 |
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OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.
OpenPayer by Trek Health — Policy intelligence for billing and revenue cycle teams.
Coverage data is sourced from publicly available payer medical policy documents and updated as payers publish revisions. Read more about where our data comes from. Always consult the primary payer source for clinical decision-making.