Prior Authorization

CareSource PASSE™ evaluates prior authorization requests based on medical necessity and benefit limits.

Navigate CareSource PASSE Prior Authorization Quick Reference Guide: Use this resource to learn how to work with CareSource PASSE regarding prior authorizations.

Services That Require Prior Authorization

Please refer to the Procedure Code Lookup Tool to check whether a service requires prior authorization. The Procedure Code Look Up Tool will also specify if your Care Coordinator needs to be involved in the Prior Authorization submission process.

Prior Authorization Procedures

The Provider Portal is the preferred and faster method to request prior authorization for some health care services including inpatient, residential and DME. You can receive immediate approval and review the status of an authorization.

Other services including Home and Community Based Services (HCBS)/Waiver, Personal Care, ABA, and outpatient services are a collaborative authorization process between the provider and the assigned Care Coordinator. **

The following is a list of available Prior Authorizations Forms:

Providers can obtain prior authorization for emergency admissions via the Provider Portal, fax or by calling Provider Services at 1-833-230-2100.

  • Fax: 937-396-3901
  • Mail: CareSource PASSE
    Attn: Utilization Management Dept.
    P.O. Box 1598
    Dayton, OH 45401-1598

**Any changes to the Prior Authorization process will be communicated on our Updates & Announcements Page.

If you are unsure of the member’s Care Coordinator, please email CareCoordination@CareSourcePASSE.com.

Nonparticipating Providers

Prior authorization must be obtained before sending patients to nonparticipating providers, with the following exceptions:

Emergency Services

All inpatient services require prior authorization. Please call 1-833-230-2100 to obtain prior authorization for emergency admissions. Outpatient emergency services do not require prior authorization. Providers must obtain an Arkansas Medicaid ID to bill for Emergency Services. Please visit the Arkansas Department of Human Services webpage to apply for an Arkansas Medicaid ID

Post Stabilization Services

Prior authorization is not required for coverage of post-stabilization services when these services are provided in any emergency department or for services in an observation setting by a participating provider.

To request prior authorization for observation services as a non-participating provider or to request authorization for an inpatient admission, please call 1-833-230-2100. During regular business hours, your call will be answered by our Utilization Management Department. If calling after regular business hours, the call will be answered by CareSource24®, our Nurse Advice Line.

Advanced Imaging Prior Authorization

Ordering physicians must obtain prior authorization for the following outpatient, non-emergent diagnostic imaging procedures:

  • MRI/MRAs
  • CT/CTA scans
  • PET scans

Ordering providers can obtain prior authorization from NIA for imaging procedures at RadMD’s website.

Pharmacy Prior Authorization

Some drugs may require prior authorization before they will be covered. Please refer to the Pharmacy page to review these requirements.

For drugs processed through Express Scripts, please refer to the Formulary or Preferred Drug List (PDL) on the Drug Formulary page. For drugs through the medical benefit, please refer to the Procedure Lookup Tool and Authorization Requirements for Medications under the Medical Benefit (coming soon).

Vision Prior Authorizations

For routine vision services, providers can submit prior authorizations through the Versant provider portal (log on credentials are needed for this site).
Providers can contact Versant at:

• Email: ecs@superiorvision.com
• Phone: 888-273-2121
• Fax: 855-313-3106

Behavioral Health Prior Authorizations

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