Forms

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    Contracting and Practice Changes

    Medical Prior Authorization

    • Medical Prior Authorization Form (coming soon) – Submit this form to request prior authorization for a medical procedure.

    Claims

    • NavigateOverpayment 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.
    • NavigateItemized Bill Cover Sheet – Submit this cover sheet and itemized statement for high dollar claims.

    Appeals

    Fraud, Waste and Abuse

    • Fraud, Waste and Abuse Reporting Form – Submit this form to report suspected fraud, waste or abuse.