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2019-20 Medicaid-BadgerCare Provider Directory-Milwaukee Updated 1/30/2020

Plans
  • iCare BadgerCare Plus
  • iCare Medicaid SSI
Document Types
  • Benefit Information
  • Provider Directories

2019-20 Medicaid-BadgerCare Provider Directory-Northeast WI Updated 1/30/2020

Plans
  • iCare BadgerCare Plus
  • iCare Medicaid SSI
Document Types
  • Benefit Information
  • Provider Directories

2019-20 Medicaid-BadgerCare Provider Directory-South-Central WI Updated 1/30/2020

Plans
  • iCare BadgerCare Plus
  • iCare Medicaid SSI
Document Types
  • Benefit Information
  • Provider Directories

2019-20 Medicaid-BadgerCare Provider Directory-Western-WI Updated 1/30/2020

Plans
  • iCare BadgerCare Plus
  • iCare Medicaid SSI
Document Types
  • Benefit Information
  • Provider Directories

2020 Additional covered OTC FCP Medicaid Only

Plans
  • iCare Family Care Partnership
Document Types
  • Benefit Information
  • Formulary/ Pharmacy Documents

2020 Aurora CompleteCare Annual Notice of Changes-Updated 2.10.20

Plans
  • Aurora CompleteCare
Document Types
  • Benefit Information
  • Plan Information

2020 Aurora CompleteCare Provider Directory-Updated 1.31.2020

Plans
  • Aurora CompleteCare
Document Types
  • Formulary/ Pharmacy Documents
  • Provider Directories

2020 Comprehensive Formulary all Medicare-Updated 1.31.20

Plans
  • iCare Medicare Plan
  • iCare Medicare Advantage Plan
  • Aurora CompleteCare
  • iCare Family Care Partnership
Document Types
  • Formulary/ Pharmacy Documents

2020 Family Care Partnership Evidence of Coverage Updated 12.11.19

Plans
  • iCare Family Care Partnership
Document Types
  • Benefit Information
  • Plan Information

2020 FCP Medicaid Only Member Pharmacy Carve Out Letter 12.11.19

Plans
  • iCare Family Care Partnership
Document Types
  • Benefit Information
  • Formulary/ Pharmacy Documents

2020 iCare FCP Annual Notice of Changes-Updated 2.10.20

Plans
  • iCare Family Care Partnership
Document Types
  • Benefit Information
  • Plan Information

2020 iCare FCP Summary of Benefits-Updated 2.10.20

Plans
  • iCare Family Care Partnership
Document Types
  • Benefit Information

2020 iCare Medicare 001 007 009 Enrollment Form

Plans
  • ALL
  • iCare Medicare Plan
  • Aurora CompleteCare
  • iCare Family Care Partnership
Document Types
  • Applications

2020 iCare Medicare Advantage Enrollment Form 011

Plans
  • iCare Medicare Advantage Plan
Document Types
  • Applications

2020 iCare Medicare Advantage Plan 011 EOC-Updated 12.11.19

Plans
  • iCare Medicare Advantage Plan
Document Types
  • Benefit Information
  • Plan Information

2020 iCare Medicare Advantage Plan Summary of Benefits-Updated 2.10.20

Plans
  • iCare Medicare Advantage Plan
Document Types
  • Benefit Information
  • Plan Information

2020 iCare Medicare Advantage Provider Directory-Updated 1.31.2020

Plans
  • iCare Medicare Advantage Plan
Document Types
  • Formulary/ Pharmacy Documents
  • Provider Directories

2020 iCare Medicare Plan Annual Notice of Changes-Updated 2.10.20

Plans
  • iCare Medicare Plan
Document Types
  • Benefit Information
  • Plan Information

2020 iCare Medicare Provider Directory Central WI-Updated 1.31.2020

Plans
  • iCare Medicare Plan
Document Types
  • Formulary/ Pharmacy Documents
  • Provider Directories

2020 iCare Medicare Provider Directory Milwaukee-Updated 1.31.2020

Plans
  • iCare Medicare Plan
Document Types
  • Formulary/ Pharmacy Documents
  • Provider Directories

2020 iCare Medicare Provider Directory Northeast WI-Updated 1.31.2020

Plans
  • iCare Medicare Plan
Document Types
  • Formulary/ Pharmacy Documents
  • Provider Directories

2020 iCare Medicare Provider Directory Western WI-Updated 1.31.2020

Plans
  • iCare Medicare Plan
Document Types
  • Formulary/ Pharmacy Documents
  • Provider Directories

2020 LIS Premium Summary Plan 011

Document Types
  • Benefit Information

2020 LIS Premium Summary Plans 001 007 009

Plans
  • iCare Medicare Plan
  • Aurora CompleteCare
  • iCare Family Care Partnership
Document Types
  • Benefit Information

2020 Part D Prior Auth Criteria Updated 2.1.20

Document Types
  • Formulary/ Pharmacy Documents

2020 Plan 001 and 009 Summary of Benefits Updated 2.10.20

Plans
  • iCare Medicare Plan
  • Aurora CompleteCare
Document Types
  • Benefit Information

2020 Plans 001 and 009 EOC - Updated 2.10.20

Plans
  • iCare Medicare Plan
  • Aurora CompleteCare
Document Types
  • Benefit Information
  • Plan Information

2020 Provider Directory Family Care Partnership-Updated 1.31.2020

Plans
  • iCare Family Care Partnership
Document Types
  • Formulary/ Pharmacy Documents
  • Provider Directories

2020 Step Therapy Rx Drug Criteria Updated 2.1.20

Document Types
  • Formulary/ Pharmacy Documents

Appeals Request Form

Document Types
  • Claims
  • Policies and Guidelines

BadgerCare Plus & Medicaid Mom & Baby Program

Plans
  • iCare BadgerCare Plus
Document Types
  • Health Education
  • Programs

BadgerCare Plus Member Handbook

Plans
  • iCare BadgerCare Plus

BC Plus Welcome Guide

Plans
  • iCare BadgerCare Plus
Document Types
  • Benefit Information
  • Plan Information

Claim Form - LTC Professional

Plans
  • iCare Family Care Partnership
Document Types
  • Claims
  • Provider Forms

CMS Appointment of Representative Form-English

Document Types
  • Applications
  • Claims
  • Policies and Guidelines

CMS Appointment of Representative Form-Spanish

Plans
  • ALL
Document Types
  • Applications
  • Claims
  • Policies and Guidelines

Consent to Receive Electronic Communications-7-2018

Plans
  • iCare Family Care Partnership
Document Types
  • Policies and Guidelines

Family Care Partnership Added Benefits Booklet

Plans
  • iCare Family Care Partnership
Document Types
  • Benefit Information

Family Care Partnership Program Brochure

Plans
  • iCare Family Care Partnership

FCP Medicaid Only Member Handbook

Plans
  • iCare Family Care Partnership
Document Types
  • Benefit Information
  • Plan Information

FCP Self-Directed Supports Brochure

Plans
  • iCare Family Care Partnership
Document Types
  • Self-Directed Supports

FCP Self-Directed Supports Guidebook

Plans
  • iCare Family Care Partnership
Document Types
  • Self-Directed Supports

Fraud Waste and Abuse Training

Document Types
  • Policies and Guidelines

iCare Limited English Proficiency Policy Statement

Document Types
  • Policies and Guidelines

iCare Medicaid SSI Intensive Care Management brochure

Plans
  • iCare Medicaid SSI
Document Types
  • Programs

iCare Medicaid SSI Member Handbook

Plans
  • iCare Medicaid SSI

Incident Reporting Guide for Members

Plans
  • iCare Medicare Plan
  • iCare Medicare Advantage Plan
  • Aurora CompleteCare
  • iCare Family Care Partnership
  • iCare BadgerCare Plus
  • iCare Medicaid SSI
Document Types
  • Health Education

Inpatient Notification Form

Plans
  • iCare Medicare Plan
  • iCare BadgerCare Plus
  • iCare Medicaid SSI
Document Types
  • Policies and Guidelines
  • Provider Forms

Letter regarding changes to Family Care Partnership Appeals and Grievances.pdf

Plans
  • iCare Family Care Partnership
Document Types
  • Grievances & Appeals
  • Policies and Guidelines

Medicaid Interpreter Services

Plans
  • iCare BadgerCare Plus
  • iCare Medicaid SSI

Medicaid SSI Welcome Guide

Plans
  • iCare Medicaid SSI
Document Types
  • Benefit Information
  • Plan Information

Medicare Multi-Language Interpreter Services

Plans
  • iCare Medicare Plan
  • Aurora CompleteCare
  • iCare Family Care Partnership

Medicare Star Ratings

Plans
  • iCare Medicare Plan
  • iCare Medicare Advantage Plan
  • Aurora CompleteCare
  • iCare Family Care Partnership
Document Types
  • Policies and Guidelines

Medication Reconciliation Post-Discharge Form

Plans
  • ALL
Document Types
  • Formulary/ Pharmacy Documents
  • Provider Forms

Notice of Nondiscrimination

Plans
  • iCare Medicare Plan
  • iCare Medicare Advantage Plan
  • Aurora CompleteCare
  • iCare Family Care Partnership
  • iCare BadgerCare Plus
  • iCare Medicaid SSI
Document Types
  • Policies and Guidelines

Notice of Privacy Practices Updated 4.15.19

Plans
  • iCare Medicare Plan
  • iCare Medicare Advantage Plan
  • Aurora CompleteCare
  • iCare Family Care Partnership
  • iCare BadgerCare Plus
  • iCare Medicaid SSI

Nurse Advice Line Brochure

Plans
  • iCare Medicare Plan
  • Aurora CompleteCare
  • iCare Family Care Partnership
  • iCare BadgerCare Plus
  • iCare Medicaid SSI
Document Types
  • Health Education

Ombuds Information (English)

Plans
  • iCare BadgerCare Plus
  • iCare Medicaid SSI
Document Types
  • Health Education
  • Policies and Guidelines

Ombuds Information (Hmong)

Document Types
  • Health Education
  • Policies and Guidelines

Ombuds Information (Spanish)

Plans
  • iCare BadgerCare Plus
  • iCare Medicaid SSI
Document Types
  • Health Education
  • Policies and Guidelines

OTC Network Covered Categories

Plans
  • iCare Medicare Plan
  • iCare Medicare Advantage Plan
  • Aurora CompleteCare
  • iCare Family Care Partnership
Document Types
  • Benefit Information
  • Formulary/ Pharmacy Documents
  • Plan Information

Part D Coverage Determination Request-Updated 1.1.19

Plans
  • iCare Medicare Plan
  • Aurora CompleteCare
  • iCare Family Care Partnership
Document Types
  • Formulary/ Pharmacy Documents
  • Prior Authorization
  • Provider Forms

Part D Redetermination Request

Document Types
  • Formulary/ Pharmacy Documents

Part D Transition Process

Plans
  • ALL
Document Types
  • Formulary/ Pharmacy Documents
  • Prior Authorization

Personal Medication List (blank)

Plans
  • iCare Medicare Plan
  • iCare Medicare Advantage Plan
  • Aurora CompleteCare
  • iCare Family Care Partnership
  • iCare BadgerCare Plus
  • iCare Medicaid SSI

Policy-Limited English Proficiency

Plans
  • iCare Medicare Plan
  • Aurora CompleteCare
  • iCare Family Care Partnership
  • iCare BadgerCare Plus
  • iCare Medicaid SSI

Request for a State Fair Hearing

Document Types
  • Applications
  • Policies and Guidelines

Scope of Sales Appointment Confirmation Form

Plans
  • iCare Medicare Plan
  • iCare Medicare Advantage Plan
  • Aurora CompleteCare
  • iCare Family Care Partnership
  • iCare BadgerCare Plus
  • iCare Medicaid SSI
Document Types
  • Plan Information
  • Policies and Guidelines

Understanding Abuse Neglect and Exploitation

Plans
  • iCare Medicare Plan
  • iCare Medicare Advantage Plan
  • Aurora CompleteCare
  • iCare Family Care Partnership
  • iCare BadgerCare Plus
  • iCare Medicaid SSI
Document Types
  • Behavioral Health
  • Health Education

What to do in Case of an Emergency

Plans
  • iCare Medicare Plan
  • Aurora CompleteCare
  • iCare Family Care Partnership
  • iCare BadgerCare Plus
  • iCare Medicaid SSI

Wisconsin Tobacco Quit Line Fact Sheet - English

Plans
  • iCare Medicare Plan
  • iCare Medicare Advantage Plan
  • Aurora CompleteCare
  • iCare Family Care Partnership
  • iCare BadgerCare Plus
  • iCare Medicaid SSI

Wisconsin Tobacco Quit Line Fact Sheet - Spanish

Plans
  • iCare Medicare Plan
  • iCare Medicare Advantage Plan
  • Aurora CompleteCare
  • iCare Family Care Partnership
  • iCare BadgerCare Plus
  • iCare Medicaid SSI

H2237_IC2203_M
Last Updated 10/1/19

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