...Request Form L Lucemyra Prior Authorization Request Form M Mental Health Medication Prior Authorization Request Form Muscular Dystrophy Prior Authorization Request Form N Narcolepsy Prior Authorization Request Form Nudexta Prior...

...The following is a list of available Prior Authorizations Forms: ABA Prior Authorization Form CES Waiver Prior Authorization Form Community Based/Behavioral Health Outpatient Prior Authorization Form EIDT/ADDT and ST/PT/OT Prior...

...benefit may also require prior authorization. Refer to the Authorization Requirements for Medications Under the Medical Benefit. For all prior authorization decisions (standard or urgent), CareSource PASSE™ provides notice to...

...you can get 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...

...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...

...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...

...the CareSource Utilization Management Department for a service that requires a prior authorization, you must submit a retro-authorization request to the CareSource Utilization Management department prior to filing a clinical...

...2025 Policy Updates 05/01/2025 Level of Care and Prior Authorization Requirements for Medicaid Covered Nursing Facility (NF) Stays 04/25/2025 Temporary Waiver of Prior Authorization Requirements for Nursing Home Admissions from...

...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...

...with the associated Drug Class within this document. Note: CareSource PA Forms are available on the Forms page under Pharmacy Prior Authorization Forms. CareSource continues to maintain and post a...