Referrals & Prior Authorization
What is prior authorization?
CareSource needs to pre-approve some services and prescription drugs. Our pre-approval is a prior authorization (PA). This means that you must get an OK from us before a provider can give you certain health care services.
Your health care provider will ask CareSource if a service needs pre-approval. Your provider can set up your visits once we approve.
CareSource will not cover some services or medications without a PA. Call us to ask if you’re not sure if a service is covered.
Services that may need a prior authorization:
- Prescription medications
- Dental care (in hospitals and ambulatory surgery centers)
- Hospital care (except emergency room)
- Medical supplies and equipment
- Inpatient services (mental health or substance use disorder services)
- Rehabilitation services
This is not a full list of services that need pre-approval. There may also be differences between the Healthy Indiana Plan and Hoosier Healthwise plans.
More details are in the HHW and HIP Summary of Benefits sections.
Questions about PA? Call Member Services or visit the benefit page links for HIP and HHW.
Services that Require a Referral
Other services like lab tests, x-rays or physical therapy need a referral. That means you must get an OK from your PMP before you can get the service. The PMP will do one of these things:
- Arrange the services for you
- Give you a written OK to take with you when you get the service
- Tell you how to get the service
Services Outside of Network
Please call us if you are not able to get the care you need from a network provider. We may work with an out-of-network provider to meet your needs
Member Services at 1-844-607-2829 (TTY: 1-800-743-3333 or 711) Monday through Friday from 8 a.m. to 8 p.m., Eastern Time.