OperatIonal Excellence

Scalable Efficiency

FOR THE OPTIMAL MEMBER AND PROVIDER EXPERIENCE

Throughout 2019, CareSource’s investments in infrastructure further enhanced our operational excellence.

By embracing and upgrading industry-leading platforms like Altruista Health’s GuidingCare® and FACETS®, and by implementing CareSource RxInnovations, our bold new pharmacy management program, we improved our scalability of operation, reliability and holistic integration of care.

These enhancements provided the scalability to expand beyond our current members and existing markets to enable us to be better prepared to deliver the CareSource level of care to more people, communities and markets.

From the provider who relies on prompt claim payments to the legislator who expects transparent accountability for every dime spent, we realize that we are a singular part of a vital health care lifeline for our members. So, internally we continue to optimize our processes and operations from top to bottom. Through our ongoing emphasis on getting things right the first time, we now rank among our industry’s leaders in operational efficiency.

When CareSource members take a sick child to the emergency room, they aren’t thinking about statistics. But for the ER staff and hospital, these performance metrics provide assurance that CareSource is doing everything we can to give our partners the support they need to do their very best work.

Doctor with stehoscope around his shoulders holding a tablet

CLAIMING EXCELLENCE

Just as we expect our providers to efficiently and reliably serve our members, we know that we must do the same for our partners.
In 2019, CareSource was among the best in the nation at meeting and exceeding State and Federal claim payment metrics.

<0.5
Days Pending Claim Volume receipts on Hand
<0.01%
Claims Aged over 30 Days
0
Non-Paper Claims Aged over 30 Days
94%
CLAIMs Systematically Processed without manual intervention
99.1%
CLAIM PAYMENT FINANCIAL ACCURACY RATE