Prior Authorization List
Full list of services that require prior authorization from CareSource PASSE; identifies service categories, behavioral health, home care, HCBS, medical supplies/DME, outpatient therapies, and pain management items that require prior authorization. Contains notes on medical necessity, exceptions (emergency care), and contact information for Member Services.
No material changes to clinical coverage or prior authorization requirements in this update.
Policy Summary
CareSource PASSE requires prior authorization for a full list of services before the plan will cover them. Services must be medically necessary — meaning needed to diagnose or treat an illness, injury, condition, disease, or its symptoms — and must be included in the member's Person-Centered Service Plan (PCSP). If the PCSP cannot be updated prior to prior authorization review, the PCSP will be added or updated after the review.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.