...submit an expedited appeal. Documentation for Good Cause for late filing of an appeal will be reviewed. An AOR form or equivalent is required for expedited preservice appeals if submitted...

Preventive care is key for the whole family. See a provider on a routine basis even if you are healthy. It helps them find and treat problems early before they...

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...