Important: Children's Community Health Plan has an updated Telehealth Policy in response to COVID-19. Please view the policy here.
Together with CCHP contracted providers are responsible for obtaining prior authorization before they provide services to covered members.
All authorization requests must be submitted via the CareWebQI Authorization tool on the Provider Portal, including all supporting documentation.
Together with CCHP utilizes a step therapy process to ensure our members can get the medication they need at the most reasonable cost. Step therapy is the practice of using specific medications first when beginning drug therapy for a medical condition. Step therapy is a type of prior authorization. In most cases, the preferred first course of treatment may be a generic drug(s) or drug(s) that is considered as the standard first-line treatment. Preferred first courses of treatment are also standard clinical practice and based on clinical practice guidelines. When trying to fill a drug that is part of a step therapy protocol, it may be automatically approved if your records show that you have already tried the preferred first course of treatment. If there is no record of you having tried the preferred first course of treatment, your physician must submit relevant clinical information to the Together with CCHP Pharmacy Department to determine if the requested drug will be covered.
If you feel that an exception to the step therapy process should be granted, your provider may file an exception request by completing the form found in the Pharmacy Authorization section of our website.
For questions or assistance with your authorization request, call Together with CCHP Clinical Services Department at 844-450-1926
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 an 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.
Children's Community Health Plan
PO Box 56099 Madison, WI 53705 1-800-482-8010
PO Box 1997, MS 6280 Milwaukee, WI 53201 1-844-201-4672