Information for Providers
Children's Community Health Plan is committed to providing the best possible service to our members and providers. We welcome you as a provider in our network and thank you for serving our members.
Listed below are the individual sections of the Provider Manual.
Download the complete CCHP Provider Manual. (PDF)
Introduction
- Welcome
- Contact information
- Integrated voice response (IVR)
Medicaid enrollment process
- Length of enrollment
- Assignment of Primary Care Clinics (PCCs)
- Medicaid identification card
- Temporary and presumptive eligibility cards
Provider responsibilities (PDF)
- Official written notice
- Physician assistance
- Locum Tenens
- Referrals
- Prior authorizations
- Requests to terminate patient/doctor relationships
- Not accepting new patients
- No-show policy
- Arranging substitute coverage
- Member notification of physician departure from network
- Transition of patient care
- Advance directives
- Medical Records
- Member rights and responsibilities
Prior authorizations
- Planned inpatient hospital admissions
- Emergency care services
- Urgent/non-emergent care
- Prior authorization list
Medicaid coding requirements
- Bilateral modifier
- Multiple surgeries
- Enhanced reimbursements
- Health personnel shortage area
Claim submission
- Completing claims
- Vendor number
- Individual practitioner number
- Initial claim submission
- Timely filing guidelines
- Claim submission reports
- Problem claim
- Request form/claim resubmission
a. Electronic Claims Transmission (ECT) confirmation report
b. Paper claims confirmation report
c. Rejected claims
- Explanation of payment
- Claim adjustments
Medicaid provider appeals process
- Claim overpayment refund
- Claim reversal adjustment
- Claim submission
- Denied service
- Paid service
- Problem claim request
- Referral authorization
Health check program
- Description
- Exam components
- Reporting and member outreach
- Billing
- Vaccines for Children program (VFC)
- Forms
ASH Reporting – Abortion, Sterilization and Hysterectomy
Prenatal Care Coordination Program
CCHP is dedicated to promoting healthy birth outcomes. We now provide prenatal care coordination for our members. As the Medical Provider, you work closely with our members to ensure that quality medical care is provided. In order to provide pregnant CCHP members with appropriate case managment services, we require you to complete and submit a notification of prenancy form. The referral form enables you to make referrals of high risk patients.
Forms and Reports
Helpful Wisconsin Medicaid links
Wisconsin Medicaid provider handbooks
Wisconsin Immunization Registry |
