...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...

...The following is a list of available Prior Authorizations Forms: ABA Prior Authorization Form CES Waiver Prior Authorization Form Community Based/Behavioral Health Outpatient Prior Authorization Form EIDT/ADDT and ST/PT/OT Prior...

...for prior authorization requests, claim submissions and more: ADA Dental Claim Form Instructions Follow the instructions to fill out the American Dental Association’s (ADA) dental claim form. CareSource TMD Screening...

...Medical Necessity for Non-Formulary Medications Medical Necessity for Non-Formulary Medications Medical Necessity for Non-Formulary Medications Medical Necessity for Non-Formulary Medications Medical Record Documentation Standards for Practitioners Medical Record Documentation Standards...

...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...

...is at least as effective in rewarding and facilitating qui tam actions for false claims as those described in the Federal False Claims Act. Indiana’s False Claims and Whistleblower Protection...

...status. CareSource accepts claims in a variety of formats, including online and paper claims. Submit Claims Online Providers have the option to submit claims through our secure, online Provider Portal*....

...you can use. Forms We want you to easily find the forms you need for your CareSource plan. Visit the Forms page to find any form when you need it....

To see your claims, log in to your My CareSource portal account and click View Claims on the My Help menu. You’ll see each claim in an easy to read...

...Reporting Form and mailing it to the address below Filling out the Fraud, Waste and Abuse Reporting Form Sending us a letter addressed to: CareSource Attn: Program Integrity P.O. Box...