CareSource® evaluates prior authorization requests based on medical necessity, medical appropriateness and benefit limits.
Covered Services and Prior Authorization Requirements
Please refer to 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.
Prior Authorization Procedures
Request prior authorization for health care services by contacting the CareSource Medical Management department by phone, fax, mail or email.
P.O. Box 743
Dayton, OH 45401
Written prior authorization requests should be submitted on the 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 authorization for 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 health partner.
To request authorization for observation services as a nonparticipating health partner or to request authorization for an inpatient admission, please call 1-844-607-2831 and follow the appropriate menu prompts.
Please call 1-844-607-2831 for any questions related to post-stabilization services.
Ordering health partners must obtain prior authorization for the following outpatient, non-emergent diagnostic imaging procedures:
- CT/CTA scans
- PET scans
Ordering health partners can obtain prior authorization from NIA for imaging procedures at their website.
DENTAL PRIOR AUTHORIZATIONS
Dental providers can submit a prior authorization via the dental web portal.