...of Representative form or the Internal Appeal Request form. Return the completed form to us along with your grievance, appeal, or request for an external review. These forms are available...

...may request authorization by one of the following mechanisms: Online submission Form for office use English | Spanish Written request via fax: 1-877-251-5896 for oral medications and injectable/specialty medications Toll-free...

...form. Disputes & Appeals Forms Appointment of Representative to File an Appeal on Patient/Member's Behalf Submit this form to request an appeal on behalf of a member. Expedited Appeal Form...

...Pathways to Coverage: https://dch.georgia.gov/georgiapathways You can find CareSource forms here: gateway.ga.gov – Use this link for the DCH Enrollment Broker site. Tell Us – Use this form when you would...

...condoms. You will need to get your prescription drugs at a pharmacy that takes CareSource. Your pharmacy benefits are provided by Gainwell. Gainwell covers all Medicaid-covered medically necessary prescription and...

...45401 Disease Management 1-844-438-9498 Care Management 1-855-202-0729 Referral fax: 844-417-6255 Behavioral Health 1-855-202-1058 Quality Improvement 1-855-202-1058 Appeals 1-855-202-1058 Fax: 1-937-531-2398 CareSource Attn: Health Partner Appeals-Georgia, P.O. Box 2008 Dayton OH...

...their prescription opioid medications, or other medications that are frequently abused. This program is called a Drug Management Program (DMP). If a member uses opioid medications that they get from...

...timeframe a member and/or provider has to appeal. To initiate the peer-to-peer process, please call CareSource’s Utilization Management team at 1-833-230-2101. CareSource® evaluates prior authorization requests based on medical necessity,...

...You can locate doctors, specialists, hospitals, clinics and more using our Find A Doctor online tool. Find pharmacies and covered medications with the Price a Medication/Find My Prescriptions tool. Learn...

...and address the most significant areas of care. Potential quality measures include the following: Antidepressant medication management Behavioral health Chronic disease management Comprehensive diabetes care Controlling high blood pressure Follow-up...