Prior Authorization

Prior Authorization Guide

Prior Authorization Forms

Pharmacy Prior Authorizations

  • For Pharmacy Prior Authorization forms, please visit our Pharmacy page.
Fax Number Reference Guide
833-238-7690 Carolina Complete Health Medicaid Face Sheets
833-238-7691 Carolina Complete Health Medicaid Assessments
833-238-7692 Carolina Complete Health Medicaid Inpatient Requests
833-238-7693 Carolina Complete Health Medicaid Medical Records
833-238-7694 Carolina Complete Health Medicaid Prior Authorization
844-975-1325 Carolina Complete Health Medicaid Census Reports
833-596-2768 Carolina Complete Health Inpatient Behavioral Health PA
833-596-2769 Carolina Complete Health Outpatient Behavioral Health PA

Non-emergent, Advanced, Outpatient Imaging Services

  • In an effort to continue promotion of quality improvement for services provided to Carolina Complete Health members, effective July 1, 2021, Carolina Complete Health will use National Imaging Associates, Inc. (NIA) to provide the management and prior authorization of non-emergent, advanced, outpatient imaging services.
  • Services managed and authorized by NIA include outpatient:
    • CT/CTA
    • CCTA
    • MRI/MRA
    • PET Scan
    • MUGA Scan
    • Myocardial Perfusion Imaging (MPI)
    • Stress Echocardiography
    • Echocardiography
  • Please visit NIA's website for Carolina Complete Health to download policies and procedures specific to both ordering providers and imaging facilities. These include quick reference guides and FAQs. You can also view information designed to assist you in using the RadMD Website to obtain and check authorizations