We want you to easily find the forms you need for your CareSource plan.  Listed below are all the forms you may need as a CareSource member.

Explanations of when and why you may need to use a form are also provided below. 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.

NavigateMember Claim Form – Use this form to request to be reimbursed if you paid for medical expenses that should have been covered under your CareSource benefits.

NavigateNavigatePrescription Reimbursement Claim Form

Member Request for a Non-Formulary Medication – you can request a drug that is not listed in our PDL.

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: 

Fraud Waste and Abuse Reporting Form – Use this form if you think a health partner or a CareSource member is committing fraud, waste or abuse. To find out more, visit the Fraud, Waste, and Abuse page.