Authorizations

CCHP will not reconsider services, procedures and inpatient stays that CCHP has not received notification for from the provider. Please reference your provider agreement with CCHP that outlines 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 make sure to attach clinical to the request within 24 hours. Without clinical to review for medical necessity, your request for services may be denied.

• 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 877-227-1142 for authorization requests for instructions on submitting their requests.

• Prior Authorization List and Codes (2017 / 2018 / 2019)
• No Prior Authorization List (2017 / 2018 / 2019)
• Non-Covered Codes (2017 / 2018 / 2019)
• Pharmacy Prior Authorizations

• Effective January 1, 2019, your office may need to submit prior authorization requests for medications differently for Together with CCHP, depending on if the drug falls to the medical benefit or the pharmacy benefit. Please be sure to read these instructions. 
• Prior Authorization List:
  These new skin substitute codes have been added to the prior authorization list: Q4183; Q4184; Q4185; Q4186; Q4187; Q4188; Q4189; Q4190; Q4191; Q4192; Q4193; Q4194; Q4195; Q4196; Q4197; Q4198; Q4200; Q4201; Q4202; Q4203; and Q4204.This is effective March 1, 2019.
  These Diabetic and Neuropathy Procedure Codes for DME and Foot Care, A5513 and A5514, have been added to the prior authorization list. This is effective March 1, 2019.
  These DME codes have been added to the prior authorization list: E0447, E0467 and L8698. Prior authorization is required if the purchase price or the monthly rental price is greater than $500. This is effective March 1, 2019.
• No Prior Authorization List:
  The following codes have been added to the no prior authorization required list: A9589; B4105; C9407; C9754; C9755; G2011; and J0841.This is effective March 1, 2019.
• Non-covered List:
  These codes were added to the non-covered list: A4563; C1823; C1890; C8937; C9751; C9752; C9753; L8701; L8702; J3591; G0068; G0069; G0070; G0071; G0076; G0077; G0078; G0079; G0080; G0081; G0082; G0083; G0084; G0085; G0086; G0087; G2010; G2012; A6460; A6461; J7318; J7329; L8608; M1000; M1001; M1002; M1003; M1004; M1005; M1006; M1007; M1008; M1009; M1010; M1011; M1012; M1013; M1014; M1015; M1016; M1017; M1018; M1019; M1020; M1022; M1023; M1024; M1025; M1026; M1027; M1028; M1029; M1030; M1031; M1032; M1033; M1034; M1035; M1036; M1037; M1038; M1039; M1040; M1041; M1042; M1043; M1044; M1045; M1046; M1047; M1048; M1049; M1050; M1051; M1052; M1053; M1054; M1055; M1056; M1057; M1058; M1059; M1060; M1061; M1062; M1063; M1064; M1065; M1066; M1067; M1068; M1069; M1070; M1071; T4545; V5171; V5172; V5181; V5211; V5212; V5213; V5214; V5215; and V5221.This is effective March 1, 2019.

BadgerCare Plus

Out-of-network providers for BadgerCare Plus must call CCHP's Clinical Services department at 877-227-1142 for authorization requests.    

• Prior Authorization List and Codes
• No Prior Authorization List

These behavioral health codes will be added to the prior authorization list and removed from the no prior authorization list with an effective date of March 11, 2019: H0005 and H0047.

These genetic codes will be added to the prior authorization list with an effective date of March 1, 2019: 81163; 81164; 81165; 81166; 81167; 81173; 81174; 81177; 81178; 81179; 81180; 81181; 81182; 81183; 81184; 81185; 81186; 81187; 81188; 81189; 81190; 81204; 81233; 81234; 81239; 81271; 81274; 81284; 81285; 81286; 81289; 81305; 81312; 81329; 81336; 81337; 81518; 81595; and E0470.

These codes will be added to the no prior authorization list with an effective date of March 1, 2019: 10004; 10005; 10006; 10007; 10008; 10009; 10010; 10011; 10012; 11102; 11103; 11104; 11105; 11106; 11107; 20932; 20933; 20934; 33275; 33286; 33440; 36572; 36573; 43762; 43763; 50436; 50437; 82642; A5514; E0447; V5171; V5181; V5211; V5221; and 99344.

Helpful Link:

• Referral policies

Submission Guides:

• Behavioral Health Authorization Request Process
• CareWeb QI Auto Authorization Tool 
• Inpatient Authorization Request
• NICU Notification
• How to submit a Synagis Prior Authorization Request