Authorizations
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Authorizations

Important: Children's Community Health Plan has an updated Telehealth Policy in response to COVID-19. Please view the policy here.

 


 

Children's Community Health Plan will not reconsider services, procedures and inpatient stays that we have not received notification for from the provider. 

Providers are required to notify CCHP within 24 hours of an inpatient admission, and prior authorize elective services and/or procedures prior to providing services. Please reference your provider agreement regarding inpatient admissions for more details.

Please attach clinical to the request within 24 hours. Without clinical to review for medical necessity, your request for services may be denied.

You may contact the UM department from 8 a.m. to 5 p.m., Monday through Friday at 414-266-4155. Messages are confidential and may be left 24 hours per day. Communications received after normal business hours will be responded to on the following business day.

  • We recommend that you check each day for authorizations that are in the draft status and have not been submitted
  • CCHP will not be notified until the authorization has been submitted
  • You can check by filtering the submission status to draft

 

Together with CCHP

Out-of-network providers for Together with CCHP need to call CCHP's Clinical Services department at 414-266-5707 for authorization requests for instructions on submitting their requests.

 

Prior Authorization List:

  • The following codes will be added to the Prior Authorization List, effective April 1, 2020:
    • Cosmetic or Reconstructive Surgery - 15769; 15771; 15772; 15773; 15774
    • Elective Surgeries - 20700; 20701; 20702; 20703; 20704; 20705; C9757
    • Positron Emission Tomography - 78429; 78430; 78431; 78432; 78433; 78434; 78830; 78831; 78832
    • EEG Video Monitoring - 95711; 95712; 95713; 95714; 95715; 95716; 95718; 95720; 95722; 95724
    • Genetic Testing - 81277; 81307; 81308; 81309; 81542; 81552
    • Miscellaneous Procedures - G2082; G2083; G2086; G2087; G2088; P9099
    • DME - E2398; A4226; E0787; L2006
  • The following codes will be deleted from the Prior Authorization List, effective April 1, 2020:
    • 0009M; 95950; 95951; 95953; 95956; C9043
  • HCPCS code E0156, for a walker's seat, was added to the prior authorization request list only if the retail cost for the code on the claim is $500 or greater. 

 

Non-covered List: 

  • The following codes have been added to the no prior authorization list: 77301; 77338; 77385; 77386; G6015; G6017. Effective December 1, 2019.

 

BadgerCare Plus

Out-of-network providers for BadgerCare Plus must call CCHP's Clinical Services department at 414-266-5707 for authorization requests.    

 

 

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

 

National Committee for Quality Assurance (NCQA) Accreditation

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