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Claims Documents

 

These and other provider-related documents can also be found on the Provider Documents page.

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Results Updated, 41 Results.

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2026 UDS Prior Auth Form

Plans
  • ALL

Ambulance Claims

Educational Resource on how to file Ambulance Claims

AVOID PAYMENT DELAY_Residential LTC Claim Tips

Chiropractor Claims Processing Guidelines

Chiropractor Claims Processing Guidelines

Claim Form - LTC Professional

Providers use this form to submit claims for long term care professional services rendered to iCare Family Care Partnership members.

Plans
  • iCare Family Care Partnership

Claim Form - LTC Residential

Providers use this form to submit claims for long term care residential services rendered to iCare Family Care Partnership members.

Plans
  • iCare Family Care Partnership

Clean Claim Requirements (CMS 1500)

The Centers for Medicare and Medicaid Services (CMS) developed claim forms that record the information needed to process and generate provider reimbursement. This document summarizes the required elements that must be complete, legible and accurate to be handled as a clean claim.

Plans
  • ALL

Clean Claim Requirements (UB-04)

The UB-04 form captures essential data elements as defined by the National Uniform Bill Committee for providers of services in institutional/inpatient/facility settings. This document summarizes the required elements that must be complete, legible and accurate to be a clean claim.

Plans
  • ALL

Durable Medical Equipment/Supplies (DME/DMS) Claims

Durable Medical Equipment/Supplies (DME/DMS) Claims

EFT Enrollment Check List

Checklist for for Providers for a Successful InstaMed ERA/EFT Enrollment

Hearing Claims

A guide to Hearing Claims

Home Health Claims

A guide to Home Health Claims

Hospice Claims

A guide to Hospice Claims

How to Submit a Professional LTC Claim

How to Submit a Residential Claim

How To_LTC Professional Claim submission via iCare Provider Portal with screenshot

How To_LTC Professional Claim submission via SSI Claimsnet

A how to for LTC Professionals: Submit a claim via SSI Claimsnet using CSV file

How To_LTC Residential Claim Submission via iCare Provider Portal with screenshot

iCare Provider Portal User Guide

iCare’s Provider Portal allows you to bill your Long Term Care Professional claims, view service authorizations and view claim information for the iCare members you serve using your personal computer, cell phone or tablet

iCare Remit Reason Codes

Remittance Reason Codes provide additional explanation for a claim

Plans
  • ALL

InstaMed Order Form - Payer Payments

Instamed Order Form - Payer Payments for Providers who do not have an National Provider Identifier (NPI) should submit this Instamed Order Form – Payer Payments form.

Long Term Care (LTC) Claims

A guide to Long Term Care (LTC) Claims

LTC DHS Medicaid Enrollment Requirements

Plans
  • iCare Family Care Partnership

LTC Residential Claim Submission via iCare Provider Portal How to Guide

Plans
  • iCare Family Care Partnership

Medicaid BadgerCare Appeal Language updated 11.7.25

Medicaid BadgerCare Appeal Language

Plans
  • iCare BadgerCare Plus
  • iCare Medicaid SSI

Medicaid FCP and SSI Appeal Language updated 11.7.25

Plans
  • iCare Family Care Partnership

Medicare Basic Dental Benefit Exception Guidelines 2024

Inextricably linked dental services require an integrated and coordinated level of care to ensure the dental services are an integral part of the Medicare covered primary procedure or service. This guideline will help to determine which dental procedures may be covered as part of a patient’s basic Medicare benefit when linked to the success of a covered medical procedure, as well as requirements to ensure efficient claims processing.

Plans
  • ALL

Mental/Behavioral Health & AODA Claims Guide

A guide to Mental/Behavioral Health & AODA Claims

New Provider Education

New Provider Education

Plans
  • ALL

Ombuds for BadgerCarePlus and SSI Medicaid HMO Members

Plans
  • ALL

PCW Agency Checklist

Plans
  • iCare BadgerCare Plus
  • iCare Medicaid SSI

PCW Institutional Outpatient Claim Submission via iCare Provider Portal How To Guide

Plans
  • iCare BadgerCare Plus
  • iCare Family Care Partnership
  • iCare Medicaid SSI

Personal Care Worker (PCW) Claims Guide

A guide to Personal Care Worker (PCW) Claims

Provider Application - Durable Medical Equipment

Durable Medical Equipment (DME) providers can apply to join iCare's network of providers by completing this application.

Plans
  • ALL

Provider Bulletin Issue 4 2024

Plans
  • ALL

Remittance Advice Guide

A provider or biller uses this guide to post payments and review claim adjustments. It contains specific claim decision information, includes adjustment reasons and codes and allows for review of denied, paid, overpaid or underpaid claims.

Review & Reopening Form - updated 2/2024

A provider uses this form to dispute a claim denial or claim amount.

SNF Claim Processing Guidelines

Skilled Nursing Facility Claims Guide

Taxonomy Code Requirements

This communication is in response to questions brought to our attention regarding claim submission requirements for iCare Medicaid claims.

Therapy Services Claims

Therapy Services Claims Processing Guideline

Vision Claims

Vision Claims Guideline

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By clicking this link, you may be leaving the iCareHealthPlan.org website. Independent Care Health Plan (iCare) only provides these links and pointers for your information and convenience. When you select a link to an outside website, you are leaving the www.iCareHealthPlan.org website.

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