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.

• 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.
• 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.