...claim denial should be submitted as an appeal. For more information about appeals, review the Appeals of Claim Denials and Adverse Decisions section on this page. If you believe your...

...(PDL), also called a formulary. The HAP CareSource PDL includes drugs on the Michigan Medicaid Managed Care Preferred Drug List and Common Formulary which are lists of drugs that all...

...you and the person that you appoint must complete the Appointment of Representative form. Return the completed form to us along with your grievance, appeal, or request for an external...

...Urine Drug Screening Prior Authorization Form – Submit this form when requesting prior authorization for urine drug screenings Submit the SUD 1115 Waiver Universal PA Form to request prior authorization...

...form. Coverage Redetermination Request Form – If you are unsatisfied with the outcome of a coverage determination request, you can file an appeal using the redetermination form. Pharmacy Prior Authorization...

...here (json) Forms Visit the Forms page to find forms when you need them. Prior Authorization List Some services require approval from CareSource MyCare Ohio before you can get them....

...easily locate all the forms you may need for your CareSource Medicare Advantage plan. Visit the Forms page to find any form when you need it. Prior Authorization List Some...

...This includes providers that perform in-office surgeries. These services should be available at no cost to the member. Submit the Interpreter Service Request Form (coming soon) to request interpretation services...

...West Virginia Health Coverage Programs and CareSource require that you submit your National Provider Identifier (NPI) number to CareSource along withthe completed West Virginia uniform credentialing and recredentialing form.Also complete...

...by completing this form. Coverage Redetermination Request Form – If you are unsatisfied with the outcome of a coverage determination request, you can file an appeal using the redetermination form....