No changes for My Choice Medicare, Family Care, and Family Care Partnership.
Authorizations
Authorization processes, secondary coverage, and non-covered services information can be found here. All authorization-related forms are in the resource library below. For other important information about programs, claims, and much more search our full Provider Resource Library; you may use the search feature to find resources by program, find a specific document or use the “Document Types” filter to limit to category-specific documents.
Commonly referenced documents
Medicare Hospice Prior Authorization Resource
April 22, 2022 | pdf (229.01 KB) | Authorizations, Prior Authorization Resource
Medicare Skilled Nursing Facility (SNF) Prior Authorization Resource
April 12, 2022 | pdf (276.39 KB) | Authorizations, Prior Authorization Resource
Medline Order Form
October 18, 2020 | pdf (297.63 KB) |
Use this form to order Medline disposable medical supplies.
MIDAS Provider Portal User Guide for EVV Services
May 17, 2021 | pdf (790.74 KB) | Claims Information
MIDAS Provider Training – Adding Users & Admin Rights
October 23, 2020 | pdf (155.03 KB) | Authorizations
My Choice Wisconsin BadgerCare Plus Claims Appeal Form
May 19, 2021 | pdf (110.12 KB) | BadgerCare Plus, Claims Information
Neurocognitive Disorders: Delirium and Dementia Clinical Practice Guideline
April 6, 2023 | pdf (307.66 KB) |
Out-of-Network Provider Referral Prior Authorization Request Form
April 22, 2022 | pdf (608.33 KB) | Authorization Request Form, Authorizations
Outpatient Behavioral Health Treatment and Services Prior Authorization Request Form
April 22, 2022 | pdf (298.33 KB) | Authorization Request Form, Authorizations
Outpatient Procedure Prior Authorization Exception List
January 26, 2024 | pdf (987.68 KB) | Authorizations
Outpatient Therapy/Cardiac/Pulmonary Rehab Prior Authorization Request Form
April 22, 2022 | pdf (243.81 KB) | Authorization Request Form, Authorizations
Physician Home & Domiciliary Visit Prior Authorization Resource
May 19, 2023 | pdf (141.48 KB) | Authorizations, Prior Authorization Resource
Physician-Administered Medication Prior Authorization Request Form
April 22, 2022 | pdf (647.96 KB) | Authorization Request Form, Authorizations
Pneumococcal Clinical Practice Guideline
December 9, 2022 | pdf (214.35 KB) | Clinical Guideline
Prior Authorization Reference Document (Requirements by Program)
April 10, 2024 | pdf (759.39 KB) | Authorizations
Prior Authorization Reopening Request Form
April 22, 2022 | pdf (172.00 KB) | Authorization Request Form, Authorizations
Procedure and Imaging Prior Authorization Request Form
April 22, 2022 | pdf (240.11 KB) | Authorization Request Form, Authorizations
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