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Authorizations

Authorizations

Many services in the Family Care, Partnership, SSI, and Medicare Dual Advantage benefit plans are covered and do not need prior authorization. For services that require prior authorization, Care Wisconsin will review the request and issue a determination, evaluating member eligibility, benefit coverage, medical necessity, location and appropriateness of services.

Coverage decisions are subject to all terms and conditions of the applicable benefit plan, including specific exclusions and limitations, and to applicable state and federal law. Providers are encouraged to confirm member’s program eligibility prior to each encounter. For a comprehensive list of prior authorization requirements for Family Care, Partnership, SSI, and Medicare Advantage Plans, see the Care Wisconsin Prior Authorizations Reference Document.

Provider Resources for Prior Authorizations

Prior Authorization Forms

All requests for Prior Authorization for acute and primary services and Medicaid State Plan must be made by faxing the approved forms below along with supporting documentation to 608-210-4050.

See the Care Wisconsin Prior Authorization Reference Document for more information on services that require Prior Authorization. Please note that Home and Community-based Waiver Services in the Family Care and Partnership benefit package require prior authorization directly from the member’s Care Team.

 

Home and Community-Based Waiver Services in Family Care

The Home and Community-based Waiver Services in the Family Care and Partnership benefit package require prior authorization from the Care Team. These services are available to meet the needs of people who prefer to get long-term care services and supports in their home or community, rather than in an institutional setting and have enrolled in Family Care or Partnership. Care Teams work with members to determine the most effective and cost effective services to promote independence and meet long term care outcomes. For information on specific services included in the Home and Community-based Waiver Services, please see the Care Wisconsin Prior Authorizations Reference Document. All Home and Community-based Waiver Services require prior authorization from the member’s Care Team. To reach the member’s Care Team, call us at 800-963-0035.

 

MIDAS Authorization Portal – Family Care Only

Access MIDAS

The MIDAS Authorization Portal is available for Family Care only. MIDAS gives Providers electronic access to search and view service authorizations.

To register for access to the MIDAS Authorization Portal please email the This email address is being protected from spambots. You need JavaScript enabled to view it.. Please include your Tax Identification Number, Location Name (s), and the Primary user’s First and Last Name.

To access the MIDAS Authorization User Guide click here

 

Disposable Medical Supply Order Forms

Care Wisconsin contracts with several providers of Disposable Medical Supplies found in our Provider Directory. For your convenience, DMS may be ordered from Medline or McKesson using the following FAX order forms

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