Forms

We want you to easily find the forms you need for your Humana – CareSource plan.  Listed below are all the forms you may need as a Humana – CareSource member.

Explanations of when and why you may need to use a form are also provided below. Look for instructions on each form. The instructions will tell you where you need to return each form, who to contact if you have questions and any next steps to take. Forms may be downloaded for printing.

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

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.

Fraud, Waste and Abuse Reporting Form – Use this form if you think a health partner or a Humana – CareSource member is committing fraud, waste or abuse. To find out more, visit the Fraud, Waste, & Abuse page.

HIPAA Authorization Form – Use this form to grant Humana – CareSource permission to speak to another individual on you or your child’s behalf, and/or release health information to someone you name. You can mail or fax the completed form to us. Please allow up to 30 days to process the hard-copy form.