Prior Authorization

TRICARE and CSMV Logo

TRICARE Prime® Demo by CareSource Military & Veterans™ evaluates prior authorization requests based on medical necessity, medical appropriateness, and benefit limits.

Services That Require Prior Authorization 

Please refer to the Procedure Code Lookup Tool to check whether a service requires prior authorization. All services that require prior authorization from us should be authorized before the service is delivered. We are not able to pay claims for services in which prior authorization is required, but not obtained by the provider.

  • 2026 Prior Authorization List (coming soon)

Prior Authorization Submission Options 

The Provider Portal is the preferred and faster method to request prior authorization for health care services. You can receive immediate approval and also review the status of an authorization.

Navigate Medical Prior Authorization Request Form

MethodContact Info

Provider Portal
(Preferred)

If you need assistance with submitting your prior authorization or have questions regarding submissions via the Provider Portal, please email CiteAutoAssistance@caresource.com and a representative will be in contact. This email is only for assistance and questions regarding prior authorizations within the Provider Portal.

Phone

1-833-230-2170 

Fax

1-844-824-5582

Sick Newborn Fax

1-937-396-3499

Mail

CareSource
P.O. Box 1307
Dayton, OH 45401-1307

Please note: Written prior authorization requests should be submitted on the Navigate Medical Prior Authorization Request Form.

Non-Participating Providers 

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

Service TypeContact Information

Emergency

Use of emergency services does not require authorization. Admissions that result from emergency room visits do require authorization.

1-800-488-0134

Post Stabilization

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.

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 Evolent, formerly known as NIA, for imaging procedures at RadMD’s website.

For additional information, visit the CareSource TRICARE (Tampa and Atlanta) Health Plan page.