CareSource Marketplace Kentucky
Welcome to the CareSource Marketplace Kentucky Health Plan page. Here you can download policies and procedures specific to both ordering and rendering providers. These include quick reference guides and information designed to assist you in using RadMD to request and check the status of prior authorizations.
If you have any questions about our programs, please contact your dedicated NIA Provider Relations Manager, Meghan Murphy.
Effective 1/1/18, in addition to the management of MR, CT and PET, prior authorization will be required for the following cardiac procedures for ONLY CareSource OH Exchange, Medicare, Medicare Advantage, ABD Adults and MAGI members as well as CareSource KY, WV and IN Exchange.
- Myocardial Perfusion Imaging (MPI)
- MUGA Scans
- Echocardiography (Transthoracic and Transesophageal Echocardiography)
- Stress Echocardiography
Note: The above cardiac procedures will NOT require prior authorization for Ohio CFC and ABD Kids and Indiana and Georgia Medicaid members.
Due to a recent Kentucky Department for Medicaid Services announcement, services performed/billed from a place of service 22 facility do not require prior authorization. This only impacts services for Kentucky Medicaid recipients. Please refer to the state website, as this is subject to change based upon additional state-issued COVID directives.
Advanced Imaging Program
- Frequently Asked Questions
- Prior Authorization Checklist
- Provider Education Presentation
- Quick Reference Guide for Ordering Provider
- Quick Reference Guide for Rendering Providers
- Tip Sheet for Ordering Advanced Imaging Studies
- Utilization Review Matrix-2022 - updated 7/1/2022
- Peer-to-Peer Process
Conservative Treatment Forms
For access to our conservative treatment forms, click here.
RadMD is a user-friendly, real-time tool offered by Magellan Healthcare that provides ordering and rendering providers with instant access to prior authorization requests for specialty procedures. Whether submitting exam requests or checking the status of prior authorization requests, providers will find RadMD to be an efficient, easy-to-navigate resource.
Search for resources by program:
Recorded General Trainings
We have a series of training videos that discuss the components of requesting a prior authorization request. Click here to access these videos.
Recorded RadMD Demos
Need additional help using RadMD? Click here to access a series of RadMD demos that demonstrate how to properly submit a prior authorization request.
- Clinical Guidelines
- Refer to the Utilization Review Matrix document to view specific codes managed by NIA
Clinical Training Modules
We have a series of clinical training modules that will help you avoid delays and ensure that you have the right information before submitting your prior authorization request. Click here to access them.
Update on COVID-19
Click here to view our recommendations on the use of CT to detect Coronavirus (COVID-19).