Caresource Georgia denials - appealing

With the recent experience of Caresource's denials for "no authorization or authorization units exceeded", this is the process on how to appeal these claims: 

Caresource requires that each appeal contain all documentation: 

https://www.caresource.com/ga/providers/tools-resources/health-partner-policies/administrative-policies/medicaid/

At this link, you can click on M for 

• Medical Record Documentation Standards for Practitioners

to find the documentation required for appeals....

Please note: 

All documentation when appealing must contain each page listing the members name, dos, page number (personally I'm going to add claim number too)

Documentation should be: 

Note from dos

Current evaluation, POC signed by md and Rx 

Proof of authorization

To submit appeal on the claim. Search for the claim on their web portal. Then find the appeal tab: 

Appeals should take 14 business days per call to customer service as of 8/18/25

If you had already appealed a claim but it was dismissed, you can appeal again. Only a second level appeal need to be performed if it's denied. Do not do a dispute unless there is a payment made on a claim.

My opinion: This isn't a glitch, this is how they plan on conducting medical review from now on.