Referrals & Prior Authorization

Some services may need to be approved by us before you can get them. Prior authorization (PA) is the approval that may be needed before you get a service. It must be medically necessary for your care. Your network provider will get prior authorization for the care you need. Network or in-network means that these providers see CareSource members. Use our Find a Doctor tool to find one near you.

Emergency care does not need prior authorization.

Referral means that your provider will request these services for you before you can get them. Your provider will either call and arrange those services for you, give you a written note to take with you, or tell you what to do.

Standing Referral

Members with ongoing care can see a specialist. A standing referral from a PCP is needed.

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.

Member Services: 1-855-202-0729 (TTY: 711), open Monday through Friday 7 a.m. to 7 p.m.