...planning or emergency services, out-of-network health care providers need prior authorization (also called pre-approval). Go to www.caresource.com/in/plans/medicaid/benefits-services/referrals-prior-authorization/ for more details on prior authorization. Office Visits / Hospital Type of Service...

...the service. Your provider can submit a request for a prior authorization using this form. A list of services that require Prior Authorization is available on the Plan Documents page....

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...on when a prior authorization is required. You can also review our prior authorization list. Supplemental Benefits For 2026, CareSource Marketplace Plans feature the following supplemental benefits: TruHearing® provider network...

...may not bill members for any covered services. To charge the member for non-covered services, the provider must obtain written acknowledgement that the member is assuming financial responsibility prior to...

...and preventive services do not need prior authorization. Many of these other services do require prior authorization. Call Member Services at 1-844-607-2829 (TTY: 711) to learn more. Dental Cleanings Yes...

...Changes to the Drug List Notification Date 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/Prior...

...for review of medical necessity outside these dates of service prior to transition. CareSource will need to be contacted via phone at 1-855-202-1058, fax at 1-844-676-0370, or email at gamedmgt@caresource.com...

...from appropriate specialties. CareSource submits to DCH for review and prior approval and as updated thereafter all clinical practice guidelines. Provider utilization of guidelines allows for the measurements of member...

The policies below are in PDF format. If you do not have Adobe Acrobat Reader, you may download it here. # A B C D E F G H I...