CareSource® evaluates prior authorization requests based on medical necessity, medical appropriateness and benefit limits.
Covered Services and Prior Authorization Requirements
Please access our covered services and prior authorization requirements to check what services require prior authorization. Please note that covered services and prior authorization requirements may differ between Healthy Indiana Plan and Hoosier Healthwise.
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 Procedures
Please use the Provider Portal to request prior authorizations for health care services. Using the portal for prior authorizations allows for immediate approval or pend status, as well as a simple way to check pending claim status. For portal login assistance, email us at CiteAutoAssistance@caresource.com. For additional information or questions about CareSource benefits, please visit the CareSource Provider Manual or Contact provider services.
Alternate methods include phone, fax or mail.
P.O. Box 44493
Dayton, OH 45401
Written prior authorization requests should be submitted on the Medical Prior Authorization Request Form.
Prior authorization must be obtained before sending patients to nonparticipating providers, with the following exceptions:
All in-patient services require prior authorization. Please call 1-844-607-2831 to obtain prior authorization for emergency admissions. Outpatient emergency services do not require prior authorization.
Post Stabilization Services
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 1-844-607-2831 and follow the appropriate menu prompts. During regular business hours, your call will be answered by our Medical Management department.
Advanced Imaging Prior Authorization
Ordering physicians must obtain prior authorization for the following outpatient, non-emergent diagnostic imaging procedures:
- CT/CTA scans
- PET scans
Ordering providers can obtain prior authorization from NIA for imaging procedures at RadMD’s website.
Dental Prior Authorization
Dental providers can submit a prior authorization via the dental web portal.