Prior Authorization is the approval that may be needed before you get a service. It must be medically necessary for your care. Your provider will get approval for the care...

...numbers for general questions, prior authorizations, claim inquiries and more, as well as common fax numbers and addresses. Use this list as a guide to help you find the appropriate...

...Code Lookup Tool and Authorization Requirements for Medications under the Medical Benefit (coming soon). Vision Prior Authorizations For routine vision services, providers can submit prior authorizations through the Versant provider...

...New Genetic Testing - Polymerase Chain Reaction Payment Policy 08/25/2016 Cite AutoAuth Expansion for Inpatient Authorizations 08/23/2016 Updated Sexually Transmitted Infection Policy 08/19/2016 Updated Interventional Pain Mgt Policies 08/19/2016 Zika...

Our Provider Manual is a resource for working with our health plan. This manual communicates policies and programs and outlines key information, such as claim submission, and reimbursement processes, authorizations,...

...partners can perform a variety of functions, including checking eligibility and claim status, submitting prior authorizations and more Provider relations staff Commitment to service Member support services How can I...

The Public Health Emergency (PHE) for COVID-19 has ended. Services like vaccines, treatment, and testing are still available. Some rules changed, stopped, or started again. CareSource continues to watch COVID-19...

...your Evidence of Coverage (EOC). You can find your EOC in your annual member material packet, or online under Plans/Plan Documents. Standard Authorizations are reviewed, and notice provided within 3...

...waste, and abuse (FWA) To enable future pharmacists to find formulary information and understand the purpose of prior authorizations To positively impact the next generation of pharmacists Expectations and Responsibilities...

...A One Front Door approach has been established to simplify the submission of claims and prior authorizations. Submitting Claims and Authorizations Providers can submit claims and prior authorizations in two...