BadgerCare Plus Authorizations

Before submitting your authorization request, please review the most recent list below for exclusions and other important information.

• Prior Authorization List (updated 11/30/2020)
  • The following codes were added to the prior authorization list with an effective date of May 1, 2020:
    • Cosmetic and Reconstructive Surgery codes 15769, 15771, 15772, 15773 and 15774
    • Durable Medical Equipment codes E2398, K0821 and K0838
    • Genetics codes 81277, 81307, 81308; 81309, 81542 and 81552
  • Specialty Medication 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.  

NOTE: The CCHP BadgerCare Plus No Prior Authorization Required List has been removed from our website. Please refer to the ForwardHealth Max Fee Schedule to determine if a code is covered for BCSP or the CCHP prior authorization list to determine if a code requires an authorization.

Submit Authorizations Online

Network providers should submit inpatient admission notifications and prior authorization requests online using the CareWebQI authorization tool via our Provider Portal at https://provider.childrenscommunityhealthplan.org/Provider-Portal. 

Out-of-network providers must call CCHP's Clinical Services department at 877-227-1142 (option 2) for authorization requests.    

The CareWebQI authorization tool gives network providers the online capability to:

• Quickly submit an authorization request
• Receive a reference number, an approval or review notification immediately
• Provide concurrent review information for inpatient admissions

Questions?

For questions or assistance with your authorization request, call:

Children’s Community Health Plan - Clinical Services Department
Toll-free: 877-227-1142, option 2
Local: (414) 266-5707

Affirmative Statement - Children’s Community Health Plan (CCHP) wants its members to get the best possible care when they need it most. To ensure this, we use a auto authorization process, which is part of our Utilization Management (UM) program. UM decision-making is based only on appropriateness of care and service, and existence of coverage. CCHP does not specifically reward practitioners or other individuals for issuing denials of coverage. Financial incentives for UM decision makers do not encourage decisions that result in underutilization.