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CareCore Policies & Payment Rules

CareCore National participating providers may be subject to payment rules specific to Radiology. The payment rules are utilized to ensure the correct coding of radiology claims and to adjust reimbursement for multiple procedures rendered to the same patient in a single office visit. To review these rules please follow the link provided below. A CareCore participating provider username and password for access to the CareCore payment rules is required. If you do not have a username/password you may submit a request for one or contact your CareCore Provider Relations Representative for assistance. Additional detailed information is provided in the CareCore/HealthPlan specific Provider Manual.

Several of CareCore‘s Health Plan clients have adopted payment rules similar to those presented here, but each Health Plan may be unique in their application of these rules. To validate the Payment Rules being applied to Radiology claims for a Health Plan, please visit the Provider Resources area of that Health Plan‘s website for specific information.

Claims Payment Portal

Appeal Forms
CareCore National Appeal Form
New York State External Appeal Application
State of New Jersey Claims Appeal Application
Review of Claim Submitted for Payment Based on Medical Necessity in New Jersey