...menu to launch the SUPDL. Prior authorization (PA) criteria links can be found with the associated Drug Class within this document. Note: PA Forms are on the Forms page under...

f Clinical Practice Guidelines CareSource approves and adopts evidence-based nationally accepted standards and clinical practice guidelines to help inform and guide the provision of clinical care to members. CPGs are...

...to CareSource with a claim form. You may download a claim form on the Forms page or call Member Services for a printed copy. If you have questions about where...

A grievance is a formal complaint about us, our providers or the care you get. You or an authorized representative may file a grievance at any time. Call Member Services...

...Form Submit this form to request continuation of care for orthodontic services. Orthodontic Evaluation and Predetermination Form Submit this form to request prior authorization for orthodontic services. Orthodontic Form for...

...DAW policy) Medical Benefit Medications Clinical Review for Formulary and Non-Formulary Medications Multi-ingredient Compound Policy # A B C D E F G H I J K L M N...

...Determination Online: Complete the Coverage Determination Request Form online. Call: Member Services Fax or Mail: Download the Coverage Determination Request Form and fax or mail it to us. Fax: 1-877-251-5896...

...filing the request for external review, you will also be required to authorize the release of your medical records as necessary to conduct the external review. You or your authorized...

...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 Authorization Changes Effective April 1, 2025 03/01/2025 Summary of Formulary/Prior...

EDUCATION SEMINARS – West Virginia Senate Bill 267 – Prior Authorizations Learn about the prior authorization changes that the West Virginia Senate Bill 267 mandates for providers and payors effective...