Forms

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Contracting and Practice Changes

Member-Related Forms

Pharmacy Prior Authorization

REMINDER – Effective October 2022, pharmacy claims and prior authorizations for drugs dispensed and billed by a pharmacy should be directed to the single pharmacy benefit manager (SPBM), Gainwell Technologies. Information for providers on www.caresource.com pharmacy pages has been reflected as notification ahead of October for the go-live of SPBM.

For prior authorizations through 9/30/2022, please continue to submit to CareSource via portal or fax at 866-930-0019 for drugs processed through the pharmacy benefit. Prior authorization forms are available in the Provider Portal. Pharmacy claims will continue to be processed by Express Scripts through 9/30/2022.

View the Unified Preferred Drug List (UPDL) here

Medical Prior Authorization

Claims

Appeals

Fraud, Waste and Abuse