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Frequently Asked Questions

What services are covered by CCHP?

CCHP providers all medically necessary services under BadgerCare Plus.

For a list of covered services, please review the CCHP Member Handbook or the Benefit and Copayment Grid. Covered services for Care4Kids can be in the C4K Member Handbook.

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How do I get a prescription filled?

Your pharmacy benefits are covered by the State of Wisconsin, not CCHP.  To fill your prescription, take it to any pharmacy that is a provider for BadgerCare Plus and show your ForwardHealth ID card to the pharmacist.

For questions about filling a prescription, call ForwardHealth Member Services at 1-800-362-3002. 

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Am I responsible for charges for the services I receive?   

Some services require you to pay a part of the cost of a service. This payment is called a “copayment.”  For a list of covered services and any copayments, please review the CCHP Member Handbook or the Benefit and Copayment Grid

If your child is covered under the Care4Kids program, please review the C4K Member Handbook.

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How can I find a CCHP provider?

You can find a provider in our provider directory.  You can also call Customer Services at 1-800-482-8010.           

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How do I get care from a primary care provider?

CCHP encourages you to have primary care provider to help manage all of your health care needs.  You can choose a primary care provider from our provider directory or by calling Customer Service at 1-800-482-8010.  If you have not met with your primary care provider recently, it’s best to schedule an appointment as soon as possible.

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How can I get specialty care, behavioral healthcare or hospital services?

Your primary care provider helps you coordinate all of your health care needs. If you need to see a specialist, a behavioral health provider or go to the hospital, your primary care provider can help you find one of our many network specialists or hospitals.

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Do I need a referral from my primary care provider to see a specialist?

You do not need a referral from your primary care doctor to see a specialist, although your primary care doctor will help coordinate all of your health care needs and can help you find one of our many network specialists and hospitals.  

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What services require prior authorization?  

Some services may require your provider to get preapproval from us before you can get the services.  For questions about services that require prior authorization, talk to your provider or call Customer Service at 1-800-482-8010.           

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Are there benefit restrictions if I see a provider who is not with CCHP?

We require our members to use CCHP network providers for covered benefits and services. You will need special permission from CCHP to see any provider who is not a CCHP provider. If you see a provider who is not with CCHP, you will be billed for those services.

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How to get a second medical opinion on my provider’s recommendation?

If you disagree with your provider’s treatment recommendations, you may be able to get a second medical opinion. A second medical opinion on recommended surgeries may be appropriate in some cases. Contact Customer Service at 1-800-482-8010 for information.

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How do I submit a claim for covered services?

If you are billed for covered services, you can send the claim to:

Children’s Community Health Plan
P.O. Box 56099
Madison, WI 53705

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What do I do if I need care after normal business hours?

Call your provider’s office or call our 24/7 nurseline CCHP on Call at 1-877-257-5861.  They will help you decide where to go for help.

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What do I do if I have an emergency?   

If you need emergency care, go to a CCHP provider if you can. If the emergency is severe, go to the nearest hospital, provider or clinic. Call 911 or your local police or fire department if the emergency is life-threatening.

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How can I get care when I’m away from home?  

If you need emergency care when you are away from home, go to the nearest hospital, urgent care clinic or provider.  For routine care away from home, you must get approval from CCHP to see a provider that is not in the CCHP network.  This includes children who are spending time away from home with a parent or relative.  For help with out-of-area services, call Customer Service at 1-800-482-8010 or an enrollment specialist at 1-800-291-2002.   

If your child is covered under the Care4Kids program, please contact the Care4Kids team.

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I would like to make a complaint. How do I do that?

If you are not satisfied us or provider, you can call a CCHP Member Advocate at 1-800-482-8010 to file a complaint or you can send your written complaint to:

Children’s Community Health Plan
Attention: Complaint and Appeals Department
P.O. Box 1997, MS6280
Milwaukee, WI, 53201-1997

You can also file a complaint the State of Wisconsin.  For more information how to file a complaint, please refer to the CCHP Member Handbook.    

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How do I appeal a decision made by CCHP?  

You or your authorized representative can appeal a decision within 90 days of our decision.  To file an appeal, you can call a Member Advocate at 1-800-482-8010 or you can send a written appeal to:

Children’s Community Health Plan
Attention: Complaint and Appeals Department
P.O. Box 1997, MS 6280
Milwaukee, WI, 53201-1997

For more information how to file an appeal and your appeals rights, please refer to the CCHP Member Handbook or call a CCHP Member Advocate.  

If your child is covered under the Care4Kid program, please review the C4K Member Handbook for information on how to file an appeal or call a CCHP Member Advocate.

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How does CCHP review new technology when deciding what services are covered?

CCHP only provides services that are covered by BadgerCare Plus.  The State of Wisconsin is always reviewing new technology as it becomes available and will let us know if the services will be covered. 

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How do I replace my a lost or stolen BadgerCare Plus ID Card?

Call ForwardHealth Member Services at 1-800-362-3002 for a new ID card or go to https://access.wisconsin.gov/

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Medicaid

Children's Community Health Plan

PO Box 56099
Madison, WI 53705
1-800-482-8010

Together with CCHP

Children's Community Health Plan

PO Box 1997, MS 6280
Milwaukee, WI 53201
1-844-201-4672

 

All Rights Reserved.
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