Forms

Tell Us: Use this form when you would like to send us a question. You can also make a complaint, file an appeal or tell us if you have any other insurance other than CareSource PASSE.

Member Consent/HIPAA Authorization Form – Use this form to share your health information with your providers or someone else:

• Fill out the form online
• Navigate Print out the form

Navigate Fraud, Waste and Abuse Reporting Form: Use this form if you think that a member, provider, or pharmacy is taking part in fraud, waste, abuse or overpayment.

Navigate Grievances and Appeals Form: Use this form if you have a complaint about a service you got or do not agree with a decision we made.

Member Services: 1-833-230-2005 (TDD/TTY: 711) Monday through Friday, 8 a.m. to 5 p.m. CT