Forms

Below, you’ll find a selection of forms and tools designed to meet your needs quickly and efficiently. Simply choose the option that best suits your purpose, and let us guide you through the process.

• Benefits and Authorization Escalation Request Form
  • Complete and submit this form to escalate a benefit or authorization request
• ACH Form
  • Complete and submit this form to initiate or update information for ACH direct deposits
• Email Confirmation for Reports
  • Complete and submit this form to initiate or update contacts receiving Claims on File, Rejection Reports and Explanation of Payments (EOP’s)
• Disclosure Authorization Form
  • Complete and submit this form to agencyupdategroup@optioncare.com to allow access of a Third-Party company to your patient information
• Claims Status Form and Instructions
  • Complete and submit this form to inquire on a claim status
• Claim Appeal Process Form and Instructions
  • Complete and submit the Provider Resolution Form to appeal any denied claims
• Agency Update Form
  • Complete and submit this form to notify CSI of changes with your agency