...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...

...Humana – CareSource regarding your privacy rights, contact the Humana – CareSource Privacy Officer at: Humana – CareSource Attn: Privacy Officer P.O. Box 221459 Louisville, KY 40252 Or, you may...

...Fill out the Grievances and Appeals form. Mail us a letter. Mail the letter to: CareSource PASSE Attn: Member Grievances P.O. Box 1947 Dayton, OH 45401-1947 Who can ask for...

...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...

...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...

These pharmacy policies apply to the TRICARE Prime® Demo by CareSource Military & Veterans™ plan. These pharmacy policies apply to our Georgia Medicaid plan(s). Pharmacy policies offer guidance on determination...

...Disease Management program, please call 1-844-438-9498. CareSource® offers care and disease management that can provide a broad spectrum of educational and follow-up services for your patients. Care Management Program CareSource’s...

...Form Submit this form to request continuation of care for orthodontic services. Orthodontic Evaluation and Predetermination Form Submit this form to request prior authorization for orthodontic services. Orthodontic Form for...

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...

We want to make sure that you are receiving the best care possible. Therefore, in certain situations, we will require your doctor to ask for approval to perform certain activities....