MedicaidPrior AuthHigh impact
[Indiana] Prior Authorization Determination Requirement Update
CareSource·IN·Provider Bulletin
Effective date
Aug 8, 2025
We identified it
May 9, 2026
Summary
CareSource (Indiana Medicaid) has updated prior authorization determination and notification timeframes effective immediately, per Senate Bill 0480.06. Key changes include: urgent pre-service requests must be determined within 24 hours (vs. standard 48 hours), inpatient/concurrent stays now have 48-hour timeframes, and providers can request peer-to-peer reconsideration within 7 business days of denial. All timeframes exclude weekends and federal holidays.
Action Required
Effective immediately (August 8, 2025): Billing and prior authorization teams must implement the following: (1) Update all prior authorization tracking systems to enforce new determination timeframes—24 hours for urgent pre-service, 48 hours for standard pre-service and inpatient/concurrent stays, and 30 days for retrospective reviews; (2) Configure system to exclude weekends and federal holidays from all timeframe calculations; (3) Establish notification workflow to inform members/representatives of missing information within 24 hours (for urgent) or 48 hours (for standard), with member given minimum 24 hours to respond; (4) Create peer-to-peer reconsideration process allowing providers to request clinical review within 7 business days of any denial; (5) Train prior authorization staff on new extension rules (max 14 calendar days if member fails to provide sufficient information); (6) Audit existing pending authorizations and expedite those approaching new deadlines. Failure to comply will result in deemed approvals, potential claim denials if authorization not obtained timely, and member grievances regarding delayed determinations.