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.
You may contact the UM department from 8:00 a.m. to 5:00 p.m., Monday through Friday at 1-844-450-1926. Messages are confidential and may be left 24 hours per day. Communications received after normal business hours are 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 877-227-1142 for authorization requests for instructions on submitting their requests.
- 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:
- 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.
- 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: Codes added:
- These codes were added to the list with an effective date of July 1, 2019: J7318; J7320; J7321; J7322; J7323; J7324; J7325; J7326; J7327; J7328 and J7329.
- HCPCS code E0156, for a walker's seat, was removed from the non-covered code list.
- These codes were added to the list: G2001, G2002, G2003, G2004, G2005, G2006, G2007, G2008, G2009, G2013, G2014, and G2015. These codes are for in-home visits post-discharge and care plan oversights. This is effective June 1, 2019.
- These lab codes were added to the non-covered code list: 0001U; 0002U; 0003U; 0005U; 0006U; 0007U; 0008U; 0009U; 0010U; 0011U; 0012U; 0013U; 0014U; 0016U; 0017U; 0018U; 0019U; 0021U; 0022U; 0023U; 0024U; 0025U; 0026U; 0027U; 0029U; 0030U; 0031U; 0032U; 0033U; 0034U; 0035U; 0036U; 0037U; 0038U; 0039U; 0040U; 0041U; 0042U; 0043U; 0044U; 0045U; 0046U; 0047U; 0048U; 0049U; 0050U; 0051U; 0052U; 0053U; 0054U; 0055U; 0056U; 0058U; 0059U; 0060U; 0061U; 0062U; 0063U; 0064U; 0065U; 0066U; 0067U; 0068U; 0069U; 0070U; 0071U; 0072U; 0073U; 0074U; 0075U; 0076U; 0077U; 0078U; 0079U; 0080U; 0081U; 0082U and 0083U. This is effective June 1, 2019.
Out-of-network providers for BadgerCare Plus must call CCHP's Clinical Services department at 877-227-1142 for authorization requests.
The Specialty Medications codes J7318 and J7329 were added to the prior authorization list with an effective date of July 1, 2019.
The Durable Medical Equipment code E2300 was added to the prior authorization list with an effective date of June 1, 2019.
The Durable Medical Equipment code E0465 was added to the prior authorization list with an effective date of May 1, 2019.