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 Prior Authorization List to check what services require 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.

Prior Authorization Procedures

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

Phone: 1-800-488-0134

Fax: 1-888-752-0012

Mail: CareSource
P.O. Box 1307
Dayton, OH 45401-1307

Email: mmauth@caresource.com

Written prior authorization requests should be submitted on the  Medical Prior Authorization Request Form.

Nonparticipating 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 1-800-488-0134 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  1-800-488-0134 and follow the appropriate menu prompts. During regular business hours, your call will be answered by our Medical Management department.

Please call 1-800-488-0134 for any questions related to post-stabilization services.

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

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.