Utilization Management
On an annual basis, CareSource completes an assessment of satisfaction with the UM process and identifies any areas for improvement opportunities.
CareSource understands that you may have questions about prior authorization. Please visit our Prior Authorization webpage.
The provider will have to provide evidence of the authorization of the services from GAMMIS or the method you received verification of services. CareSource will provide an authorization from the date of eligibility with CareSource to the end of the already approved service. The provider will have to submit a request for any additional services for review of medical necessity outside these dates of service prior to transition.
We are committed to ensuring the quality and appropriateness of health care services provided to our members. The Utilization Management department performs all utilization management (UM) activities including prior authorization, concurrent review, discharge planning and other activities. We make our UM criteria available on this webpage and in writing through the following forms of communication:
- Mail: CareSource, Attn: Medical Management Dept., P.O. Box 1307, Dayton, OH 45401
- Fax: 1-844-676-0370
On an annual basis, we complete an assessment of satisfaction with the UM process and identify any areas for improvement opportunities.