- Grievance/Appeal 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.
- Prescription Reimbursement Claim Form
- Fraud, Waste and Abuse Reporting Form – Use this form if you think a health partner or a CareSource member is committing fraud, waste or abuse. To find out more, visit the Fraud, Waste, & Abuse page.
- 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. Or, download this hard-copy version and mail or fax the completed form to us. Please allow up to 30 days to process the hard-copy form.
- IRS 1095B Form
- Letter from Georgia Department of Community Health
- More Information
- Frequently Asked Questions about the 1095B Tax Form
Member Services: 1-855-202-0729 (TTY: 1-800-255-0056 or 711), Monday – Friday 7 a.m. – 7 p.m.