Forms
We want you to easily find the forms you need for your HAP CareSource plan. Listed below are all the forms you may need as a HAP CareSource member and an explanation of what each form is.
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.
- Pharmacy Reimbursement Form
- Fraud, Waste and Abuse Reporting Form – Use this form if you think a health partner or a HAP 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. Mail or fax the completed form to us. Please allow up to 30 days to process the hard-copy form.
- Member Claim Form
Member Services: 1-833-230-2053 (TTY: 711), 24 hours a day, seven days a week.