...Member Exception Request Form – Use this online form to ask for an exception to a drug listed on the CareSource Marketplace Drug Formulary Internal Appeal Request Form – Use...

...AZ 85072-2000 Providers can complete the Coverage Determination Request Form to provide supporting statements for an exception request. Appeals If you are unsatisfied with the outcome of a coverage determination...

...or if you disagree with any part of our appeal (redetermination or reconsideration) decision, you can request further appeal levels. Complete details on all appeal levels can be found in...

...or Find A Claim Provider Appeals Provider Appeals View appeal requirements and time frames and submit appeals. View or Submit Need Assistance? If you have questions, CareSource is here to...

...acerca de sus derechos o si necesita ayuda, llame a Servicios para Afiliados. También puede escribirnos a: CareSource Attention:  Georgia Member Grievance and Appeal P.O. Box 1947 Dayton, OH  45401...