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Administrative Policies
https://www.caresource.com/providers/tools-resources/health-partner-policies/administrative-policies/...Testing N Non-Invasive Vascular Studies Nonmedical Community Supports and Services P Person-Centered Service Plans Program Integrity Provider Prepayment Review R Relatives or Guardians as Paid Providers Retrospective Authorization Review S...
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Preferred Drug List
https://www.caresource.com/plans/medicaid/benefits-services/pharmacy/preferred-drug-list/...receipt of a pharmacy prior authorization request. If it is an emergency, a 72-hour override may be used so that you can get your medicine. Prior authorization requests for a...
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Drug Formulary Changes
https://www.caresource.com/providers/tools-resources/drug-formulary/drug-formulary-changes/...Authorization Changes Effective April 1, 2026 03/01/2026 Summary of Formulary/Prior Authorization Changes Effective January 1, 2026 12/01/2025 Summary of Formulary/Prior Authorization Changes Effective October 1, 2025 09/01/2025 Summary of Formulary/Prior...
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Benefits and Services
https://www.caresource.com/plans/marketplace/benefits-services/...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...
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Hoosier Healthwise (HHW) Benefits & Services
https://www.caresource.com/plans/medicaid/benefits-services/hhw-benefits/...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...
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Healthy Indiana Plan (HIP) Benefits & Services
https://www.caresource.com/plans/medicaid/benefits-services/hip-benefits/...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...
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Dental
https://www.caresource.com/providers/education/patient-care/dental/...form to evaluate scaling and root planning. ODJFS Dental Services Prior Authorization Form Submit this form to the Ohio Department of Job and Family Services (ODJFS) to request prior authorization...
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Preferred Drug List
https://www.caresource.com/plans/caresource-passe/benefits/pharmacy/preferred-drug-list/...Authorization Changes Effective January 1, 2026 12/01/2025 Summary of Formulary/Prior Authorization Changes Effective October 1, 2025 09/01/2025 Summary of Formulary/Prior Authorization Changes Effective July 1, 2025 06/01/2025 Summary of Formulary/Prior...
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ICD-10
https://www.caresource.com/providers/education/icd-10/...Our ICD-10 resources include network notifications, frequently asked questions (FAQs), claim processing and preauthorization updates, as well as additional resources from the Centers for Medicare & Medicaid Services (CMS) and...
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Claims
https://www.caresource.com/providers/provider-portal/claims/...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...
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