Forms

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.
  • Navigate Member 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.
  • 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:
  • Navigate Member Appeals Form – Use this form to file a grievance/complaint or to appeal a decision.
  • 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.
  • DisposeRX® Request Form – Get a free DisposeRx packet to help you dispose of unused or expired medications.
  • Advance Directives – Learn how to make a written record about your future care and treatment while you are healthy.
  • Mywww.caresource.com – log in to your personal online account to change your primary care provider, request a new ID card, change your address, see your claim information, and more.

Member Services: 1-800-488-0134 (TTY: 1-800-750-0750 or 711), Monday – Friday 7 a.m. to 8 p.m.