...pre-service appeal. This is considered a member appeal and will be resolved within 30 days plus any extension, if applicable, for a standard appeal. See ‘Extending an Appeal” for more...

To learn more about appeals and how to file an appeal for your plan, choose your plan from the drop down list above, then click GO. An appeal is how...

...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...

...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...

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...

...options. WHERE TO GET CARE Forms Forms All the forms you need in one place. Find Forms Submit a Grievance or Appeal Submit a Grievance or Appeal If you are...

...submissions. Alternative Option: Paper Claims Paper claim forms are encouraged only for services that require clinical documentation or other forms to process. Refer to the Provider Manual for instructions to...

Please choose your plan from the drop down list above and click GO to see applicable forms. These forms allow caregivers to work with CareSource on behalf of their loved...

...with CareSource and the service we provide. However, health partners who are unhappy with CareSource’s action concerning a medical necessity decision or a claim payment may appeal it. Please see...

...drug reimbursement. NADAC pricing can be accessed on Medicaid.gov. Pricing information can also be accessed through the secure Express Scripts Provider Portal. Drug pricing appeals can be completed through the...