...an adult/patient-centered model, starting prior to the age of 14 and continuing into young adulthood for CSHCS enrollees and those within foster care. The goal of HCT is to assist...

...is the best care for your needs. The UM department performs activities such as: prior authorization (PA), pre-service review, expedited review, post-service review, discharge planning and other utilization activities. If...

...this means: Covering services without any limits or need of a prior authorization. This includes services done by out-of-network providers. Using a special claims payment process to make sure providers...

We Want to Keep Your Data Safe. We have a new safety feature on our Provider Portal that will help safeguard information and add additional security to user accounts. It’s...

...role of CANS in determining OhioRISE eligibility. This flier can be distributed by CANS assessors prior to or at the time of a CANS assessment. Care Coordination Portal Access Training...

...practical tools that you can use in your everyday practice as you strive to make SUD education and screening a priority when seeing members. Substance Use Disorder Information Resources We...

...are open Monday through Friday, 8 a.m. to 4:30 p.m. CT. Prior Authorization CareSource PASSE may ask your provider why you need a certain type or dose of medicine. Prior...

...Claims Prior Authorization Prior Authorization View prior authorization requirements and processes. Prior Authorization Forms Forms Find important forms for doing business with CareSource. View Forms Updates & Announcements Updates &...

...to receive concerns about a violation of our standards of conduct or policies and procedures. Please review the following prior to submitting: We ask that you work with us to...

Notification Date Posted Summary of Formulary/Prior Authorization Changes Effective July 1, 2026 06/01/2026 Summary of Formulary/Prior Authorization Changes Effective April 1, 2026 03/01/2026 Summary of Formulary Changes Effective January 1,...