...information (SHI). The Member Consent/HIPAA Authorization Form can also be used to designate a person to speak on the member’s behalf. Please encourage CareSource members who have not consented to...

...You can use the Consent for Provider to File an Appeal on Patient/Member’s Behalf form to record this consent. Now Available: Provider Fair Hearing Plan The Provider Fair Hearing Plan...

...a health partner or a CareSource member is committing fraud, waste or abuse. Visit Fraud, Waste, & Abuse. Member Consent/HIPAA Authorization Form – Use this form to give your consent...

...Consent Forms Reminder 03/05/2020 Access and Availability Standards 03/02/2020 Policy Updates March 2020 03/01/2020 Notice of DentaQuest Dental Plan Administration Implementation Date Change – This notification has been revised. See...

...you’re in stable condition, unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services. Certain services at an in-network hospital or...

...the address on the bottom of the form. Appeals Forms Consent for Provider to File an Appeal on Patient/Member's Behalf Submit this form to request an appeal on behalf of...

...data with your new plan. You will need to ask your current plan to request your data from CareSource PASSE. We must have record of your consent to share your...

...parent of legal guardian. An attorney with your written consent. When can you ask for an appeal? You can ask for an appeal within 60 calendar days of the date...

...or any identification or account numbers related to the individual, with or without their permission or consent; Be in violation of any law, or depict any materials or images that...

...explicit consent of a parent or legal guardian is required if you are under the age of 21, then you may be required to secure such consent prior to submitting...