Provider Notes: Information for our Healthcare Providers
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Children's Community Health Plan's Provider Notes - Information for our Healthcare Providers
In this issue:
 
Questions regarding how to bill?
If you or your office have Medicaid billing questions for Children’s Community Health Plan’s (CCHP) Medicaid members please refer to the Forward Health web site. CCHP follows Medicaid benefit and billing guidelines. The Forward Health portal references Medicaid policies and procedures.

Children’s Community Health Plan – Medicaid
Please submit CCHP Medicaid claims to:
Children's Community Health Plan
PO Box 56099
Madison, WI  53705
 
Together with Children’s Community Health Plan – Marketplace Product
Providers can use the Together with CCHP provider portal to access claims status and member eligibility information. Providers can also submit claims through the Together Provider Portal. There is a user guide on the childrenscommunityhealthplan.org web site to help navigate the portal. Claims for Together with CCHP members should be sent to:

Together with CCHP
P.O. Box 106013
Pittsburgh, PA. 15230-6013
 
As a reminder, Provider Relations Representatives are available for on-site educational trainings or webinars. Although our team members cannot instruct you on how to bill we can provide you with resources that can help you and would enjoy the opportunity to meet with your teams.  We can be reached at 844-229-2775.

 
Provider Appeals
How do I appeal a claim determination?
Providers have the right to appeal a claim if they do not agree with how it was processed. CCHP has provider appeal forms available for both BadgerCare Plus - CCHP and Together with CCHP in the Provider Forms section of our website. Using the correct provider appeal form ensures CCHP receives all the needed information and helps avoid delays in processing appeals. Please be sure to include all supporting documentation with the provider appeal form.

BadgerCare Plus - CCHP, please complete this form and mail the completed form to:
Children’s Community Health Plan
P.O. Box 56099
Madison, WI 53705

Together with CCHP, please complete this form and mail the completed form to:
Together with CCHP
Attn.: Appeals Department
P.O. Box 1997, MS 6280
Milwaukee, WI 53201
Provider Portal
Are you registered for the portal?
Registering with the CCHP Provider Portal is the key to accessing online services, forms, prior authorizations and more. Learn more about registering here!

Have you upgraded?
Our provider portal, which is used for checking claim status, verifying eligibility and submitting  prior authorizations, had a security upgrade. As a result,  all users are required to have  TLS (Transport Layer Security) 1.1. or higher as of July 22, 2017.  Please contact your IS department or CCHP support if you need help with the upgrade at 414-266-5747.
Clinical Services
What does CCHP Depression Disease Management Program do?
CCHP’s care team provides education, self-management support and connection to resources for behavioral healthOur goal is to enhance members’ ability to manage their condition and improve overall health outcomes and quality of life. Providers can find out more about the program at CCHP's website.  
A recent success story from Depression Disease Management Program involved the team being able to help a young mother of three small children with post-partum depression with psychosis. 

If you wish to refer your patients to the program here are links for BadgerCare Plus - CCHP and Together with CCHP. 
Clinical and Preventive Guidelines
CCHP supplies Clinical Practice Guidelines on both medical and behavioral health conditions as a resource for providers. These evidence-based guidelines recommend best practices in adult and well child visits and annual check-ups. Our Clinical and Preventive Guidelines assist clinicians by providing a framework for the evaluation and treatment of patients. Access the Clinical Practice Guidelines on our website at this link.
Authorization List Updates
BadgerCare Plus - CCHP has updated the list of  services that do not require prior authorization for BadgerCare Plus – CCHP members. View this list.
Together with CCHP authorization lists remain the same and there have not been any changes at this time.


View all Authorization Lists. 
 
As a reminder all authorizations for both Medicaid and Together members must be submitted through our auto-authorization tool, CareWeb, located in the CCHP Provider Portal. A very important tip is listed below. 
Submitting Prior Authorizations Tip
Did you know that if you do not hit the submit button CCHP will not receive the request for prior authorization? There are more tips for submitting authorizations including inpatient admission on the website.

Payment Processing

Would you like to receive Electronic Funds Transfer payments?

If you are interested in receiving electronic funds transfer for BadgerCare Plus - CCHP please fill out this form and email the completed for to: eftenrollment@changehealthcare.com. It can, also, be faxed to 615-238-9615. 

If you are interested in receiving electronic reimbursement from Together with CCHP for medical services please complete this form and mail it or fax it to:

Together with CCHP
P.O. Box 106014
Pittsburgh, PA 15230-6014
Fax: 1-844-549-3744
Provider Directory
Have you checked your information lately on the provider directory? View the directory here.
 
BadgerCare Plus - CCHP and Together with CCHP provide online resources to help you and your patients locate primary care providers, specialists, hospitals, community health centers, and other medical facilities.

If any of your contact information has changed or is not listed accurately in our Provider Directory, please go to our website and complete the Provider Directory Update/Change form. Here are links for the forms for Together with CCHP and BadgerCare Plus - CCHP. Next, email it to: cchp-providerupdates@chw.org. 
BadgerCare Plus - CCHP Notes
Expansion approved for BadgerCare Plus - CCHP! 

CCHP is growing! Wisconsin’s Department of Health Services has approved CCHP to expand its network into Jefferson and Manitowoc counties this July. This allows us to serve more of the BadgerCare Plus population.
If you have questions about this expansion, please contact your Provider Relations Representative at 844-229-2775.
Provider-Administered Drugs Claims for BadgerCare Plus - CCHP
Forward Health’s Provider-administered drugs “carve out policy” identifies when drugs should be submitted to ForwardHealth or the members HMO.  Forward Health will not accept certain place of service codes so it’s important to refer to Forward Health’s topic 4382 for information on claims submissions. For more information please refer to this link.
What does the Care4Kids program do?
Care4Kids is a Medicaid benefit that provides comprehensive health care for children in out-of-home care that reflects the unique health needs of these children in foster care.
Care4Kids provides children with primary care physicians who are trained in the needs of children in out-of-home care, and also creates a team of professionals who coordinate care for the child.

The Care4Kids team is facilitated by an outreach coordinator and health care coordinator.  this team is comprised of the county caseworkers, health care professionals, out-of-home care providers, and the child's family.

This program operates under a “medical home” philosophy by establishing a primary care medical home team for each child designed to address each child’s specific health care needs.  Learn more about the program here. 
Together with CCHP

Together is getting a new look!

CCHP is in the process of rebranding Together with CCHP with the goal of having it completely rolled out January 1, 2018. The new brand rollout will take place in multiple phases with a focus on open enrollment materials first. The logo is being changed to reflect that coverage is for adults and children.

Together with CCHP’s team has been out in the community including at Newaukee’s Night Markets, Lighthouse Run and various farmer’s markets. More information about the events can be found on Together with CCHP's Facebook page.

Disclaimers:

Affirmative statement: Utilization Management decision-making is based only on appropriateness of care and service, and existence of coverage. BadgerCare Plus - 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.

Network: Together with CCHP does not use quality measures, member experience measures or cost-related measures to select practitioners or hospitals. After several years of Marketplace experience, Together may begin utilizing these measures to select practitioners/hospitals.

 

Copyright © 2017 Children's Community Health Plan, All rights reserved.
Children’s Community Health Plan (CCHP), owned by Children’s Hospital of Wisconsin, is dedicated to providing access to the highest quality health care and services to BadgerCare Plus - CCHP members and Together with CCHP members.

Our mailing address is:
Children's Community Health Plan
PO Box 1997-6280
Milwaukee, WI 53201
(800) 482-8010
childrenscommunityhealthplan.org/providers


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