Prior Authorization

CareSource® 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 CareSource should be authorized before the service is delivered. CareSource is not able to pay claims for services in which prior authorization is required but not obtained by the provider.

Use the Quick Reference Guide to check the services and codes that require prior authorization for CareSource’s plans.

Prior Authorization Statistics

Please access the Navigate Indiana Annual Codes Report to view the year’s statistics.

Prior Authorization Procedures

Request prior authorization for health care services via the Provider Portal or by phone, fax or mail.

Phone: 1-833-230-2101
Fax: 1-844-676-0372


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

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:

Emergency Services

All in-patient services require prior authorization. Please call 1-833-230-2101 to obtain prior authorization for emergency admissions. Outpatient emergency services do not require prior authorization.

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 nonparticipating provider or to request authorization for an inpatient admission, please call 1-833-230-2101 and follow the appropriate menu prompts. During regular business hours, your call will be answered by our Medical Management department.

Please call 1-833-230-2101 for any questions related to post-stabilization services.

Dental Prior Authorization

Marketplace dental providers can submit a dental authorization request via the DentaQuest Provider Web Portal.