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...

...(prior authorization) in order for it to be covered by your plan. The health partner who orders the drug should help you get a prior authorization. The prior authorization requirements...

...the Find a Doctor tool has our most up-to-date list of network providers. Forms Visit the Forms page to find forms when you need them. Prior Authorization List Prior authorization...

Our Provider Manual is a resource for working with our health plan. This manual communicates policies and programs and outlines key information, such as claim submission, and reimbursement processes, authorizations,...

...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...

...Care form – PCP to Specialist (coming soon) Coordination of Care form – Specialist to PCP (coming soon) Depression Reference Guide Find a Doctor Forms Pregnancy Transportation & Interpreter Services...

...on the Indiana Health Coverage Programs (IHCP) Pharmacy Services page. Select Preferred Drug List from the Preferred Products dropdown menu to launch the SUPDL. Prior Authorization (PA) criteria links can...

...menu to launch the SUPDL. Prior authorization (PA) criteria links can be found with the associated Drug Class within this document. Note: PA Forms are on the Forms page under...

...materials all in one place. Documents Forms Forms Get the forms you need to make the most of your plan. Forms Where to get Care Where to get Care Get...

...Change Form. Once complete, email the form to providernetwork@hap.org with the subject line: Provider Change Form. In the body of the email, be sure to include: Type 1 NPI Type...