- Provider Attestation Form – Submit this form to attest to practice competency prior to working with CareSource.
- CCVS Provider Authorization and Release Form – Submit this form to authorize release of credentialing information to CareSource.
- Organizational Credentialing Application – This form should be completed by organization/facility for credentialing.
- Debarment Form – Use this form to provide ownership of disclosure information.
- CareSource Common Roster Template – This form should be completed by large facilities needing to add a large number of providers. Providers may attach the completed form to their New Health Partner Contracting Form application, or email the form to us if they’ve already filled out an application.