No Referral Needed

The following services do not require a referral from your PCP. This means that your PCP does not need to arrange or approve these services for you. Just check your Provider Directory for a list of participating providers who offer these services and schedule an appointment yourself. If you are not sure what types of providers offer any of these services, please call CareSource for help.

  • Primary Care Provider services - You can make unlimited visits to the participating provider you choose as your PCP.
  • Yearly well-adult exams
  • Shots (immunizations)
  • Preventive mammogram (breast) and cervical cancer (Pap smear) exams
  • Physical exams - Those required for employment or for participation in job training programs if the exam is not provided free of charge by another source
  • Federally Qualified Health Center (FQHC) or Rural Health Clinic (RHC) services
  • Family planning services and supplies - You may receive services from your PCP or any obstetrician, gynecologist or qualified family planning provider listed in your Provider Directory such as Planned Parenthood.
  • Obstetrical (maternity care – prenatal and postpartum, including at-risk pregnancy services) and gynecological services - You may go to any participating Obstetrician or Gynecologist (OB/GYN) listed in your Provider Directory.
  • Certified nurse midwife services - You may go to a Certified Nurse Midwife (CNM). Check the Provider Directory or call CareSource for the names of available CNMs.
  • Certified Nurse Practitioner services - If you would like to see a Certified Nurse Practitioner (CNP), check the Provider Directory or call CareSource for the names of available CNPs.
  • Emergency services - Please see Where to get Care.
  • Mental health and substance abuse services - If you need mental health and/or substance abuse services, please call Member Services at 1-800-993-0780, or you may self-refer directly to a Community Mental Health Center or Ohio Department of Alcohol and Drug Addiction Services (ODADAS) facility which is a Medicaid Provider. Please see your Provider Directory, call Member Services or visit our website at www.caresource.com for the names and telephone numbers of the facilities near you.

You may go to any participating psychologist without a referral. You can make up to 25 visits per year without a referral or prior authorization. You need a referral from your PCP to see a psychiatrist except for those at community mental health centers. Please call us if you have questions.

  • Vision (optical) services, including eye glasses - Routine checkups and services from optometrists, as well as eye glasses, do not require a referral. Other services require a referral from your PCP or optometrist and/or prior authorization from CareSource. You can get glasses once every two years unless medically necessary.
  • Dental services - Good dental care is an important part of your health. You should visit your dentist for a routine dental exam every six months. These exams help catch problems early. Then you can get proper treatment to help correct any problems before they get worse. CareSource will pay for two dental exams every year. CareSource will also cover the following:
    • X-rays
    • Fillings
    • Simple extractions
    • Impacted tooth extractions
    • General anesthesia
    • Anterior (front teeth) root canals

CareSource may also pay for one set of full or partial dentures every eight years with prior authorization. Routine checkups and cleanings do not require a referral. We encourage you to get a checkup every six months. Some services may require a referral from your dentist and/or prior authorization from CareSource. Your dentist will take care of this for you. Please contact Member Services at 1-800-993-0780 (TTY: 1-800-750-0750 or 711) if you have any questions about your dental benefit coverage.

  • Chiropractic (back) services - Members can have up to 15 visits per year without a referral or prior authorization.
  • Podiatry (foot) care
  • Speech and hearing services - You can have up to 30 visits per year for speech therapy without a referral or prior authorization. Hearing exams do not require a referral or prior authorization.
  • Services for children with medical handicaps (Title V) - Services can be obtained from your PCP or from a specialist with a PCP referral.
  • Medical supplies - These require a prescription. Some supplies do require a referral and/or Prior Authorization from CareSource.