Forms

We want you to easily find the forms and documents you need for your CareSource PASSE plan. Explanations of when and why you may need to use a form or document are also provided below.

• 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:
  • Member Consent/HIPAA Authorization Form – Online
  • Navigate Member Consent/HIPAA Authorization Form - Hard copy
• 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.