...Just call Member Services at 1-833-230-2005 (TDD/TTY: 711) Monday through Friday, 8 a.m. to 5 p.m. CT. You can also contact us online through the Tell Us form. What if...

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...

...designated by the Centers for Medicare & Medicaid Services (CMS), National Uniform Billing Committee (NUBC) and the American Dental Association (ADA). We cannot accept handwritten claims or superbills. Tips for...

...ending. You can appeal if you disagree. You must ask for one within 60 days from the date listed on the letter. You or an authorized representative can file. Call...

...Health Outcomes Survey Over and underutilization patterns and trends On an annual basis, we formally evaluate our QI program and performance metrics against set goals. Our formal results inform our...

...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...

A grievance is a formal complaint about us, our providers or the care you get. You or an authorized representative may file a grievance at any time. Call Member Services...

...the Access Opportunity Form. The Access Opportunity Form gives you a chance to suggest a provider for our network, tell us about things like if it is easy to schedule...

...Determination Online: Complete the Coverage Determination Request Form online. Call: Member Services Fax or Mail: Download the Coverage Determination Request Form and fax or mail it to us. Fax: 1-877-251-5896...

...filing the request for external review, you will also be required to authorize the release of your medical records as necessary to conduct the external review. You or your authorized...