...Co.® Utilization Management department. You may submit clinical appeals pre- or post-service. All pre-service appeals are clinical appeals and require the member’s signed and dated Appointment of Representative (AOR). For...

...You can also speak to one of our nurses by calling CareSource24®. Abdominal Aortic Aneurysm (AAA) Screen: For men ages of 65 to 75 who have smoked. Annual Physical Exam:...

We have compiled all of the essential forms in one place for you to utilize. Select the applicable form(s) for reporting, credentialing, claims, and more. Note: You may need to...

We want you to easily find the forms you need for your CareSource plan. Listed below are all the forms you may need as a CareSource member. To see the...

...45401-1947 Email: AORforms@caresource.com. Coverage Determinations (Decisions) A decision we make about the payment for a Part D drug or an exception to our formulary. If you believe you are entitled...

...Abdominal Aortic Aneurysm (AAA) Screening ✓   Annual Physical Exam ✓ ✓ Breast Cancer Screen   ✓ Cervical Cancer Screen   ✓ Cholesterol Screen ✓ ✓ Colon Cancer Screen ✓...

...an Appointment of Representative Form. Complete it by Mail: Send it to CareSource, P.O. Box 1947, Dayton, OH 45401-1947 Email: AORforms@caresource.com. CareSource Member Services at 1-833-230-2020 (TTY: 1-833-711-4711 or 711)....

...Cancer Breast Cancer Lung Cancer Prostate Cancer Cardiovascular disorders Aortic aneurysm or Abdominal Aortic aneurysm Atrial fibrillation (A-Fib) Cardiac (Heart) arrhythmias (heart flutters or “skips a beat) Coronary Artery Disease...

...Lung Cancer Prostate Cancer Cardiovascular disorders Aortic aneurysm or Abdominal Aortic aneurysm Atrial fibrillation (A-Fib) Cardiac (Heart) arrhythmias (heart flutters or “skips a beat) Coronary Artery Disease (CAD) Hypertension (High...

Preventive services include: “Welcome to Medicare” preventive visit (one-time). Abdominal aortic aneurysm screening. Alcohol misuse counseling. Bone mass measurement. Breast cancer screening (mammogram). Cardiovascular disease (behavioral therapy). Cardiovascular screenings. Cervical...