Note: This message is displayed if (1) your browser is not standards-compliant or (2) you have you disabled CSS. Read our Policies for more information.
All services, except pharmacy, lab and X-ray, must be approved by either a prior authorization (PA) or by a linkage of the provider to the participant for services related to the participant’s eligible medical condition. A PA confirms medical necessity and the relationship of the service to an eligible medical diagnosis. Services provided by a linked provider in their office do not require PA. Providers are responsible for obtaining PA from the Children's Special Health Care Services (CSHCS) Program for covered services when necessary. Providers should contact the Prior Authorization Section by telephone and fax a copy of their evaluation or consultant records from the patient’s medical chart. The fax number is 1-317-233-1342; the telephone number is 1-317-233-1351 or 1-800-475-1355, PA option (Option 3). CSHCS has developed a draft Prior Authorization Request form. The use of this form is required when submitting requests for prior authorization. Please contact us at the number above for a copy of the form. Complete and submit the form each time you request a prior authorization, along with any other necessary documentation. This form will help to streamline the authorization process and allow us to make a determination more quickly and efficiently. Below is a list of services that require prior authorization to allow payment by CSHCS; however, this list is not all-inclusive.