Referrals & Prior Authorization

You can get many services without a referral from your Primary Care Provider (PCP). Your PCP does not need to arrange or approve them. Find a doctor with the Find a Doctor/Provider tool. Set up a visit.

Your doctor will get you a Navigate prior authorization (PA) for you for services that need one. from us for services that need one.

  • You need a PA when you see a provider who is out of network, a Navigate (PA) is needed.
  • You do not need a PA for an emergency.
  • You do not need a PA for visits or procedures with in-network providers.

Services that Need a Referral

Your provider will ask for some services before you can get them. This can be lab tests, x-rays, or seeing specialists. Your PCP will:

  • Arrange the services for you.
  • Give you a written note to take with you when you get the service.
  • Tell you how to get the service.

Services that Require a Referral and Prior Authorization

A few services need a referral and/or PA. Your PCP will know if this is needed.

Services Outside of Network

CareSource may work with a provider out-of-network to set up needed services. This happens if you cannot get care from an in-network provider. You must have PA before getting care out of network. Your PCP will get a PA for you.

Standing Referral

Members with ongoing care can see a specialist. A standing referral from a PCP is needed. The treatment given by the specialist for your health needs.

Continuity of Care

CareSource will work with you to keep getting your planned current care. We can help with continuing care if:

  • You are new to CareSource.
  • Your provider has left the network.
  • You leave CareSource.