Prior Authorization

HAP CareSource™ MI Coordinated Health (HMO D-SNP) 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 HAP CareSource MI Coordinated Health should be authorized before the service is delivered. HAP CareSource MI Coordinated Health is not able to pay claims for services in which prior authorization is required but not obtained by the provider.

HAP CareSource MI Coordinated Health does not require referrals to see an in-network specialist. The specialist may require a referral from the member’s PCP. Some services and procedures require prior authorization. Referrals and prior authorizations must be obtained prior to services being rendered. 

• Navigate Prior Authorization List

Prior Authorization Submission Options

Urgent requests should be marked urgent. Urgent requests will be accepted when the member or their physician believes waiting for a decision under the standard time frame could place the member’s life, health or ability to regain maximum function in serious jeopardy. Referrals and prior authorization for services should be made to in-network providers whenever possible. Contracted providers can be found in our online Provider Directory.

Written prior authorization requests should be submitted on the Medical Prior Authorization Request Form (coming soon).

Non-Participating Providers

Prior authorization must be obtained before sending patients to nonparticipating providers, with the following exceptions:

Advanced Imaging Prior Authorization

Ordering physicians must obtain prior authorization for the following outpatient, non-emergent diagnostic imaging procedures:

• MRI/MRAs
• CT/CTA scans
• PET scans