Prior Authorization

Emergency services, family planning, post stabilization services, and table top x-rays do not require prior authorization. 

How to Secure Prior Authorization (PDF)

Prior authorizations can be submitted in 3 ways: 

  1. The Secure Provider Portal 
  2. Phone​
  3. Fax​
    Medical PA Fax: 1-833-238-7694
    BH Inpatient Fax: 1-833-596-2768
    BH Outpatient Fax: 1-833-596-2769
    Pharmacy PA Fax: 1-866-399-0929

For Prior Authorization Form, please visit our Manuals, Forms, and Guides page.

For Behavioral Health UM Prior Authorization Guidelines, please visit our Manuals, Forms, and Guides page.

  • For Behavioral Health, please see state bulletin regarding COVID-19 flexibilities for specifics related to BH 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 Concurrent Review
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

National Imaging Associate's prior authorization program for 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
  • 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