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 other insurance besides CareSource.

Member Claim Form: Use this form to request a reimbursement if you paid for services that should have been paid by CareSource.

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

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

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

DisposeRx® Request Form: Get a free DisposeRx packet to help you dispose of unused or expired medications.

Advance Directives: Learn how to make a written record about your future care and treatment while you are healthy.

Questions? Call Member Services at 1-800-488-0134 (TTY: 711). We are open Monday through Friday, 7 a.m. to 8 p.m.