CareSource PASSE™ evaluates prior authorization requests based on medical necessity and benefit limits.
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:
- ABA Prior Authorization Form
- CES Waiver Prior Authorization Form
- Community Based/Behavioral Health Outpatient Prior Authorization Form
- Community Support and Services Providers / CSSP Prior Authorization Form
- EIDT/ADDT and ST/PT/OT Prior Authorization Form
- ICF / Respite / HDC Prior Authorization Form
- Medical Prior Authorization Form
- Personal Care Prior Authorization Form
- Psych Inpatient Prior Authorization Form
- Supportive Living Prior Authorization Request Form
- Therapeutic Communities Prior Authorization Request Form
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.
Prior authorization must be obtained before sending patients to nonparticipating providers, with the following exceptions:
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:
- 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:
Behavioral Health Prior Authorizations
- 2022 Behavioral Health Medicaid Benefits Continuum Resource
- 2022 HCBS Medicaid Benefits Continuum Resource