Forms

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    Contracting and Practice Changes

    Member-Related Forms

    Medical Prior Authorization

    Claims

    • ECHO Health Enrollment – Submit this form to enroll with ECHO Health, our electronic funds transfer partner.
    • Navigate Overpayment Recovery Form – Submit this form to offset overpaid claims against a future payment.
    • Claim Refund Check Form (coming soon) – Mail your refund check, this form and any other required documentation to CareSource.
    • Navigate Itemized Bill Cover Sheet – Submit this cover sheet and itemized statement for high dollar claims.

    Appeals

    Fraud, Waste and Abuse