...A CareSource member or appointed representative may complete this form when applicable. Appointment of Representative Form An appointed representative is a relative, friend, advocate, provider or other person authorized to...

...areCareSource Dual Advantage™ (HMO SNP) isCareSource MyCare ohio isCareSource isCareSource Marketplace Indiana isCareSource Marketplace KentuckyCareSource Marketplace West Virginia is listed as an authorized health plan. If not, check the Authorized...

...authorized under state law to act for you will need to sign an Appointment of Representative Form. Complete it by: Mail: Send it to CareSource, P.O. Box 1947, Dayton, OH...

...the right to: File a complaint (also called a grievance) File an appeal Ask for an external review Authorized Representative In order for CareSource to talk to your authorized representative,...

...CareSource Attn: Member Grievance & Appeals P.O. Box 1947 Dayton, OH 45401-1947 If you have chosen an authorized representative, remember to fill out the Appointment of Representative Form. Learn more...

...in filing a grievance, coverage determination, organization determination or appeal. We call these people appointed representatives. Those not authorized under state law to act for you will need to sign...

You or your authorized representative can ask for a State Fair Hearing if you do not agree with the appeal decision. You can also ask if is not resolved within...

...8 a.m. to 8 p.m., except holidays. Follow the menu options to speak to a representative from the department you need. How do I make a referral? CareSource uses a...

...can also review our prior authorization list. Services We are here to help you. Your services include: Member Services: Our Member Services representatives are available toll-free to answer your questions...

...Mail the form or letter to: CareSource Attn: Member Grievance & Appeals P.O. Box 1947 Dayton, OH 45401-1947 If you have chosen an authorized representative, remember to fill out the...