​Caring Starts with Your Rights

Care Wisconsin protects member rights and has clear policies and procedures to address the concerns of members if they or their representatives are ever dissatisfied with decisions or services. We have a well-defined process that meets all Wisconsin Department of Health Services (DHS) requirements. We encourage members to exercise their rights and our goal is for the member to have a positive experience.

If you are unhappy or dissatisfied with a decision, first discuss it with your care team. Talking with your team is usually the fastest and easiest way to address your concerns.

If you do not want to talk with your team, call our Member Rights Specialist at 1-800-963-0035 ext. 3448 Monday-Friday. 8 a.m.-4:30 p.m. Our Member Rights Specialist can tell you about your rights, attempt to informally resolve your concerns, and help you file a grievance or appeal.

Understanding Grievances & Appeals

Grievances & Appeals Process

Contact Information By Program

Providers

Resource Downloads For Grievances & Appeals

You will need Adobe Acrobat Reader to view and print PDF files. Download A Free Copy If you need materials in other formats or languages: Visit Help In Other Languages.

​Family Care Grievance Process Diagram

June 12, 2018 | pdf (95.08 KB)

Learn how to address your concerns or problems with Care Wisconsin, one of our providers, or the quality of your care or services.

​Family Care Appeal Process Diagram

June 12, 2018 | pdf (57.44 KB)

Learn how to request a review of your care team's decision about your services.

Appointment of Representative Form CMS-1696

June 12, 2018 | pdf (69.47 KB)

If you want someone else to represent you in a grievance or appeal, print out and complete this form.

Partnership Medicaid-Only Grievance Process

June 12, 2018 | pdf (79.10 KB)

Learn about the grievance process for Medicaid-only Partnership members.

Partnership Medicaid-Only Grievance Form

June 12, 2018 | pdf (39.50 KB)

Use this form to file a grievance with Care Wisconsin.

Medicare Prescription Drug Coverage Determination Form

June 12, 2018 | pdf (103.25 KB)

Ask for a coverage determination or exception by completing this form.

Redetermination of Medicare Prescription Drug Denial

June 12, 2018 | pdf (44.19 KB)

Ask for a coverage redetermination (appeal) of a Medicare Part D prescription drug by completing this form.

More Ways To Contact Care Wisconsin

Help In Other Languages

Find out how to access interpreter services or other resources in a way that works for you.

Translation Services

Locations

Care Wisconsin has four programs across 51 Wisconsin counties.

Find CW Locations

Report Fraud, Waste & Abuse

We take issues of noncompliance seriously. Find out how to report them here.

How To Report