CareSource Prior Authorization

CareSource publishes service-specific prior authorization guidance. Start with the payer resource below, then confirm the member's plan and the requested service before care is scheduled or submitted.

At a glance

• CareSource Nevada Medicaid requires prior authorization for services on its list; the provider portal is the preferred submission method. Emergency care does not need prior authorization, but emergency-room admissions do. Standard decisions are due within 7 calendar days, urgent decisions within 2 business days or 72 hours, and some request types may have specific extension rules.
• Authorizations are not a guarantee of payment.
• All services requiring prior authorization should be authorized before service delivery.
• CareSource states it cannot pay claims when prior authorization was required but not obtained.
• The Nevada page lists a '2026 Prior Authorization List' while the manual contains plan-wide Medicaid guidance; service-specific requirements should be checked by code.

Where to verify prior authorization requirements

• Verification resource 1
• Verification resource 2
• Verification resource 3

How to submit prior authorization requests

• Provider Portal (preferred)

• Phone

• Fax

• Mail

• Submission resource 1

• Submission resource 2

Information commonly required

• Clinical information supporting medical necessity
• Requested service/procedure details
• Member eligibility should be verified on the date of service
• If appealing a medical-necessity denial, member consent is required

Turnaround notes and caveats

• Standard preservice decisions: no later than 7 calendar days after receipt of the request
• Urgent preservice decisions: within 2 business days or 72 hours, whichever is sooner
• Concurrent review: 3 calendar days
• Retro/post-service requests: 30 calendar days
• Urgent incomplete requests: provider has 48 hours to respond to an additional-information request; the plan may extend urgent determinations once by up to 14 calendar days
• Authorizations are not a guarantee of payment.
• All services requiring prior authorization should be authorized before service delivery.
• CareSource states it cannot pay claims when prior authorization was required but not obtained.
• The Nevada page lists a '2026 Prior Authorization List' while the manual contains plan-wide Medicaid guidance; service-specific requirements should be checked by code.

Provider resources

• Nevada Medicaid Provider Manual (PDF) (official)
• Nevada Medicaid Provider Claims page (official)
• Nevada Medicaid Prior Authorization page (official)
• Nevada Medicaid Provider Contact Us (official)
• Nevada Medicaid Provider Disputes or Appeals (official)

Sources