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
- COF Instructions
-
- Refer to these instructions when reviewing your Claims on File (COF) report