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2023 Family Care Partnership Evidence of Coverage Updated 12/2/2022

Plans
  • iCare Family Care Partnership
Document Types
  • Plan Information

2023 Family Care Partnership Medicaid only Diabetic Supplies

Plans
  • iCare Family Care Partnership
  • iCare Medicaid SSI
Document Types
  • Formulary/ Pharmacy Documents

2023 Hard Copy Request Notice

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

2023 iCare Family Care Partnership Annual Notice of Changes

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

2023 iCare Family Care Partnership Provider Directory Updated 2/1/23

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

2023 iCare Family Care Partnership Summary of Benefits

Plans
  • iCare Family Care Partnership
Document Types
  • Benefit Information

2023 iCare Medicare Comprehensive Formulary eff 3/1/23

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

2023 iCare Medicare Enrollment Form V2 FILLABLE

2023 iCare Medicare Plan Annual Notice of Changes

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

2023 iCare Medicare Plan Benefits Update

Plans
  • iCare Medicare Plan
Document Types
  • Benefit Information

2023 iCare Medicare Plan Evidence of Coverage Updated 12/2/2022

Plans
  • iCare Medicare Plan
Document Types
  • Plan Information

2023 iCare Medicare Plan Summary of Benefits

Plans
  • iCare Medicare Plan
Document Types
  • Benefit Information

2023 iCare Medicare Plans LIS Premium Summary

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

2023 iCare Medicare Provider Directory NE WI Updated 2/1/23

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

2023 iCare Medicare Provider Directory NW WI - Updated 2/1/23

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

2023 iCare Medicare Provider Directory SC-SW WI- Updated 2/1/23

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

2023 iCare Medicare Provider Directory SE WI - Updated 2/1/23

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

2023 Part D Prior Auth Criteria-eff 3/1/23

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

2023 Step Therapy Rx Drug Criteria eff 3/1/23

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

Advance Directives - Power of Attorney, Living Will brochure

Plans
  • ALL

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 & Medicaid SSI Member Handbook

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

BadgerCare 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

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

COVID 19 Vaccine FAQ Flyer

Document Types
  • COVID-19
  • Health Education

Equal Employment Opportunity Affirmative Action Policy Statement

Document Types
  • Policies and Guidelines

Family Care Partnership Appeals and Grievances Update

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

Family Care Partnership Program Information brochure

Plans
  • iCare Family Care Partnership

FCP CM-002 Partnership Member Rights.pdf

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

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 Medicare Plan and FCP Enrollment Form

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

Incident Reporting Guide for Members

Plans
  • iCare Medicare 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
  • Prior Authorization
  • Provider Forms

MA-027 Member Rights and Responsibilities.pdf

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

Medicaid Appointment of Representative Form-Grievence and Appeal.pdf

Plans
  • iCare Medicare Plan
  • iCare Family Care Partnership
  • iCare Medicaid SSI

Medicaid Appointment of Representative Form-Organization

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

Medicaid Appointment of Representative Form-Person

Plans
  • iCare Medicare Plan
  • iCare Family Care Partnership
  • iCare Medicaid SSI

Medicaid Interpreter Services

Plans
  • iCare BadgerCare Plus
  • iCare Medicaid SSI

Medicaid SSI Welcome Guide

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

Medicaid-SSI-BC Plus Provider Directory-Milwaukee-Updated 3/1/23

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

Medicaid-SSI-BC Plus Provider Directory-Northeast WI Updated 3/1/23

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

Medicaid-SSI-BC Plus Provider Directory-South-Central WI Updated 3/1/23

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

Medicaid-SSI-BC Plus Provider Directory-Western-WI Updated 3/1/23

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

Medicare Member Reimbursement Request Form

Plans
  • iCare Medicare Plan
  • iCare Family Care Partnership

Medicare Multi-Language Interpreter Services

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

Medicare Star Ratings

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

Notice of Privacy Practices

Document Types
  • Policies and Guidelines

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

Opioid Education 2022 for Family Care Partnership members

Plans
  • iCare Family Care Partnership
Document Types
  • Health Education

Opioid Education 2022 for iCare Medicare Plan members

Plans
  • iCare Medicare Plan
Document Types
  • Health Education

OTC Network Covered Categories

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

Part D Coverage Determination Request

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
  • Aurora CompleteCare
  • iCare Family Care Partnership
  • iCare BadgerCare Plus
  • iCare Medicaid SSI

Policy QI-013 Quality Improvement Program Oversight

Document Types
  • Policies and Guidelines

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
  • 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
  • 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
  • Aurora CompleteCare
  • iCare Family Care Partnership
  • iCare BadgerCare Plus
  • iCare Medicaid SSI

Wisconsin Tobacco Quit Line Fact Sheet - Spanish

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

Disclaimers

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Last Updated 10/15/22

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