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Contracting and Practice Changes

  • New Health Partner Contract Form – Submit this form if you are interested in becoming a CareSource North Carolina Co.® provider. This form can also be used to change your tax ID number, as well as add products. Need help? Refer to the User’s Guide for Completing the New Health Partner Contract Form. If you have additional general questions about the New Health Partner Contract Form, call Provider Services at 1-833-230-2101.
  • Provider Maintenance Form – Use the Provider Portal to alert CareSource North Carolina Co. to changes in your practice. Login to the portal and select “Provider Maintenance” from the navigation.

Member-Related Forms

Pharmacy Prior Authorization

Medical Prior Authorization



  • Navigate Standard Appeal Form – Submit this form to request an appeal for a claim denial or a medical necessity/utilization management decision.

Fraud, Waste and Abuse