Starting October 1, 2019, Care Wisconsin will provide centralized processing of all Skilled Nursing Facility Authorizations for Family Care and Partnership. This will align processes with our SSI and Dual Advantage programs and will allow for a faster, more efficient process! The updated guidelines and an educational PA resource guide can be found for reference in the Provider Resource Library.
If you have questions, please reach out to Customer Services at 1-800-963-0035.
• Let us know – Prior authorization is required for all Skilled Nursing Facility Admissions. Please fax the completed Skilled Nursing Facility and Long Term Acute Care Prior Authorization Request Form and supporting clinical documentation to 608-210-4050.
• Initial Review – Once we have been notified of the potential admission, the member’s case will be assigned to a Utilization Review RN who will process for medical necessity using InterQual and other evidenced based clinical standards of care.
• Care Management – Care Wisconsin Care team staff is always available to discuss our Member’s discharge needs.
• Concurrent Review – Concurrent review is completed every 1-2 weeks for Skilled/Rehabilitative Stays. Custodial stays (related to a long term care need) are authorized for longer periods of time and reviewed less frequently. Please send updated clinical information to support the continued stay prior to the authorization end date for a prompt review. Clinical documentation can be faxed to 608-210-4050.
• Notification of Decision – The Member, requesting provider, and servicing provider will receive prompt written notification within one business day of receiving pertinent clinical information to make the determination. Skilled Nursing Facility authorizations created after 10/1/2019 are not viewable on Care Wisconsin’s Authorization Portal. Authorization notification letters will be sent via fax to the contact you list on your prior authorization request or mail if fax is not available.