The member’s primary insurance requires prior authorization for inpatient rehabilitation and so does CareSource. Do I need to obtain prior authorizations from both plans?
Providers must comply with the plan rules of the primary insurance carrier. If the primary carrier makes payment on the claim, a second authorization from CareSource is not required. The claim should then be submitted to CareSource as secondary. We will reimburse for this service if the primary payment is less than our allowable rate. If the primary denies the claim for procedural reasons, CareSource becomes the primary plan and therefore, prior authorization would be required.
