CurrentCareSourcePolicy Pass-Through Billing-AR PASSE-AD-1267

Pass-through Billing (Arkansas PASSE)

Defines CareSource's pass-through billing rules for Arkansas PASSE providers; applies to providers billing CareSource for services and their staff in Arkansas.

Policy Summary

PayerCareSource

PolicyPass-through Billing (Arkansas PASSE)

Policy CodePolicy Pass-Through Billing-AR PASSE-AD-1267

Change TypeNo material changes

Effective DateFeb 1, 2023

Next Review Date

Key ActionProviders must bill only for services they or their direct employees perform and under direct supervision when appropriate.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

1primary policy statement

02/01/2023effective date

02/28/2023archive date

10/26/2022date issued

Pass-through Billing Coverage Criteria

Pass-through billing coverage criteria

Conditions under which billing is permitted or prohibited:

Pass-through billing is not permitted; providers must not bill CareSource for services they did not perform.

Providers will only be reimbursed for services performed by the provider or by staff under the direct supervision of the provider who bills for the services.

Providers must bill CareSource only for those services which they or their direct employees perform; providers will not bill, charge, seek payment for, or submit any claims to CareSource for pass-through billed services and have no recourse against CareSource or its members for such amounts.

If there is a conflict between this Administrative Policy Statement and the plan contract (Evidence of Coverage), the plan contract controls.

Billing Codes and Restrictions

Policy Summary

PayerCareSource

PolicyPass-through Billing (Arkansas PASSE)

Policy CodePolicy Pass-Through Billing-AR PASSE-AD-1267

Change TypeNo material changes

Effective DateFeb 1, 2023

Next Review Date

Key ActionProviders must bill only for services they or their direct employees perform and under direct supervision when appropriate.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Billing restrictionsmixedNot Covered

No codes listed

Billing allowed only for — services performed by the provider or direct employees under direct supervision.

Allowed billersProviders may only bill for services they or their staff perform.

Supervision requirementReimbursement is limited to services performed by the provider or by staff under the provider's direct supervision.

Employee limitationProviders must bill CareSource only for services their direct employees perform.

No recourse for pass-through chargesProviders will not bill, charge, seek payment for, or submit claims to CareSource for pass-through billed services and have no recourse against CareSource or members for such amounts.

Provider Billing Requirements and Prohibitions

Denial Risk

Pass-through billing prohibition

CareSource does not permit pass-through billing; providers may only bill for services they or their direct employees perform, and reimbursement is limited to services performed by the provider or staff under the provider's direct supervision.

Providers must bill CareSource only for services they or their direct employees perform.
CareSource will only reimburse providers for services performed by the provider or by staff under the provider's direct supervision.
Providers may not bill, charge, seek payment for, or submit claims to CareSource for pass-through billed services and have no recourse against CareSource or members for such amounts.

Definitions

Pass-through billing — definition and explanation.

DefinitionPass-through billing occurs when the ordering physician, professional provider, facility or ancillary provider requests and bills for a service that is not performed by that ordering provider; you may only bill for services that you or your staff perform.

Policy stanceCareSource does not permit pass-through billing.

Billing prohibition detailsProviders must not bill, charge, seek payment for, or submit claims to CareSource for services they did not perform.

Conflict with contractIf there is a conflict between this Administrative Policy Statement and the plan contract (Evidence of Coverage), the plan contract controls.