Prior Authorization
CareSource® evaluates prior authorization requests based on medical necessity, medical appropriateness, and benefit limits.
Covered Services and Prior Authorization Requirements
Please access our covered services and prior authorization requirements to check what services require prior authorization. Please note that covered services and prior authorization requirements may differ between Healthy Indiana Plan and Hoosier Healthwise.
Access the CareSource Indiana Medicaid Prior Authorization List
Please refer to the Procedure Code Lookup Tool to check whether a service requires prior authorization. All services that require prior authorization from CareSource should be authorized before the service is delivered. CareSource is not able to pay claims for services in which prior authorization is required, but not obtained by the provider.
Prior Authorization Submission Options
| Method | Contact Info |
|---|---|
Provider Portal (Preferred) | The Provider Portal is the preferred and fastest method to request prior authorization for health care services. You can receive immediate approval and also review the status of an authorization. If you need assistance with submitting your prior authorization or have questions regarding submissions via the portal please email CiteAutoAssistance@caresource.com and a representative will be in contact. This email is only for assistance and questions regarding prior authorizations within the Provider Portal. |
Phone | |
Fax | Fax: 1-844-417-6157 |
CareSource Note: Written prior authorization requests should be submitted on the Medical Prior Authorization Request Form. |
Non-Participating Providers
Prior authorization must be obtained before sending patients to non – participating providers, with the following exceptions:
Emergency Services
All in-patient services require prior authorization. Please call 1-844-607-2831 to obtain prior authorization for emergency admissions. Outpatient emergency services do not require prior authorization.
Prior authorization is not required for coverage of post-stabilization services when these services are provided in any emergency department or for services in an observation setting by a participating provider.
To request prior authorization for observation services as a non – participating provider or to request authorization for an inpatient admission, please call 1-844-607-2831 and follow the appropriate menu prompts. During regular business hours, your call will be answered by our Utilization Management department.
Please call 1-844-607-2831 for any questions related to post-stabilization services.
Pharmacy Prior Authorization
Some drugs may require prior authorization before they will be covered. Please refer to the Pharmacy page to review these requirements.
For drugs processed through Express Scripts, please refer to the Formulary or Preferred Drug List (PDL) on the Drug Formulary page. For drugs processed through the medical benefit, please refer to the Procedure Code Lookup Tool and Authorization Requirements for Medications Under the Medical Benefit under Prior Authorization.
Substance Use Disorder Prior Authorization
The following forms are residential and inpatient Substance Use Disorder (SUD) treatment.
Dental Prior Authorization
Medicaid dental providers can submit a dental authorization request via the SkyGen Portal.