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Past Updates & Announcements
https://www.caresource.com/providers/tools-resources/updates-announcements/past/...6/07/2022 12/22/2022 Synagis Prior Authorization Resources Notification 12/19/2022 Prior Authorization Requirement for Non-Participating Laboratory Services 12/13/2022 Pharmacy Policy Updates - January 2023 12/09/2022 Unified Preferred Drug List (UPDL) Changes 12/07/2022...
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General Plan Information
https://www.caresource.com/plans/marketplace/plan-documents/general-plan-information/...authorization. Although your provider should get a prior authorization from us, you may want to ensure that your provider has received our approved prior authorization. Many other services do not...
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Provider Disputes or Appeals
https://www.caresource.com/providers/provider-portal/appeals/...webpage. Post-Service Appeal: denial of an authorization for a service that has already been completed. You have 180 days from date of service, discharge or authorization denial to submit a...
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Contact Us
https://www.caresource.com/providers/contact-us/...for Behavioral Health and Individuals with Development Disabilities (BH and I/DD), Prior Authorization 1-833-230-2100 Monday through Friday, 8 a.m. to 5 p.m. CT ServiceDeterminations@CareSourcePASSE.com Fax: 844-542-2605 Pharmacy Prior Authorization 1-833-230-2100...
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Utilization Management
https://www.caresource.com/providers/education/patient-care/utilization-management/...the UM process and identifies any areas for improvement opportunities. Prior Authorization CareSource understands that you may have questions about prior authorization. Access the Prior Authorization webpage for detailed information....
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Updates & Announcements
https://www.caresource.com/providers/tools-resources/updates-announcements/...Update 05/13/2025 Level of Care and Prior Authorization Requirements for Medicaid Covered Nursing Facility (NF) Stays – UPDATE 05/05/2025 May 2025 Policy Updates 05/01/2025 Level of Care and Prior Authorization...
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FAQs
https://www.caresource.com/providers/education/faqs/...Department of Community Health’s (DCH’s) central prior authorization portal for communicating prior authorization and precertification requests and their disposition. How do I request a retrospective review? Health partners have 180...
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MUSCULOSKELETAL AND CARDIAC SURGICAL PROCEDURES
https://www.caresource.com/providers/tools-resources/health-partner-policies/surgical-procedures/...Authorization & Provider Portal Portal providers and/or their delegates should follow Ohio Department of Medicaid’s (ODM) guidelines to submit prior authorization requests and supporting documentation through the Ohio Medicaid PNM...
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Provider Resources
https://www.caresource.com/providers/provider-portal/...Check Eligibility Prior Authorization Prior Authorization View prior authorization requirements and submit authorization requests. View or Submit Update Practice Information Update Practice Information Alert us to changes in your practice....
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Forms
https://www.caresource.com/members/tools-resources/forms/...Member Consent/HIPAA Authorization Form – Online Member Consent/HIPAA Authorization Form - Hard copy Fraud Waste and Abuse Reporting Form – Use this form if you think a health partner or...
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