Forms

Tell Us: Use this form when you would like to send us a question or request online.

Member Consent/HIPAA Authorization Form – Use this form to give your consent to share your health information with your providers and/or release health information to someone you name:

Navigate Fraud, Waste and Abuse Reporting Form: If you suspect that a member, provider, or pharmacy is participating in fraud, waste, abuse or overpayment, please let us know.

Navigate Grievances and Appeals Form: Use this form when you have a complaint about service you have received or would like to dispute a decision that has been made.

Member Services: 1-833-230-2005 (TDD/TTY: 711) Monday through Friday, 8 a.m. to 5 p.m. CT