...formulary If prior authorization, quantity limits and/or step therapy restrictions are added for a drug If a drug is moved to a higher cost-sharing tier If the FDA deems a...

...in the first 90 days of your membership and your medication is not on our covered drug list (formulary) or coverage is limited in some way, such as prior authorization,...

...limitations. This may include requiring a prior authorization, step therapy, or quantity limit. The prior authorization requirements for your medicines may change. Questions? Call Member Services. The comprehensive formulary, pharmacy...

...Drug List Prior Authorization Criteria – For certain drugs, your doctor will need to contact us before you can fill your prescription. 2025 Prior Authorization Criteria Last updated on 12/01/2025...

...claim. At a minimum, the dispute submission must include: Claim payment disputes must be submitted in writing. If your denial involves a denied authorization request involving a medical necessity review...

...Medical equipment Having medical supplies like breathing equipment and others, delivered to your home. Quantity limits and prior authorizations are waived. This includes: medical supplies such as diabetic supplies, incontinence...

Common Ground Healthcare is now CareSource! We have a new name, but our commitment is the same. We make health insurance simple to use and easy to understand. Open Enrollment...

...learn more about CareSource PASSE’s collaboration with BetterDoctor, view the BetterDoctor FAQs. Up-to-date contact information is critical to process your claims and prior authorization requests. In addition, it ensures our...

...get from out-of-network providers and understand how to ask for authorization for such services. To follow established processes for prior authorization when requesting inpatient services and letting TrueCare know of...

...get from out-of-network providers and understand how to ask for authorization for such services. To follow established processes for prior authorization when requesting inpatient services and letting TrueCare know of...