Before submitting your authorization request, please review the most recent list below for exclusions and other important information.
- Prior Authorization List (updated 09/05/2019)
- 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.
- No Prior Authorization List
- A5513 was added to the no prior authorization list on 08-30-2019
- 31253; 31257; 31259 were added to the no prior authorization list on 06-20-2019
- 50435 was added to the no prior authorization list on 05-31-2019
Submit Authorizations Online
Network providers should submit inpatient admission notifications and prior authorization requests online using the CareWebQI authorization tool via our 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
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.