BadgerCare Plus Providers: Utilization Review Policy Change Effective 8/1/2021

Effective August 1, 2021, referrals from a Primary Care Provider (PCP) to an in-network Specialist are no longer required. Any initial (first time) in-network Specialist claim received after July 31, 2021 will not be reviewed for a valid referral.

All authorization requirements remain in place.

Updated forms can be found in the provider resource libraries on our website August 1st. Please use these new forms and replace older saved versions.

For more information about the policy change and what is defined as an in-network Specialist claim, please see the BadgerCare Plus Provider Handbook found in the Provider Library on our website.