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Referrals and Prior Authorizations

for members of BadgerCare Plus, SSI Medicaid and Family Care Partnership

 

NOTE:  EMERGENCY SERVICES DO NOT REQUIRE PRIOR AUTHORIZATION!

Referrals

Your provider handles most referrals. For example, to obtain a referral to an in-network provider, please contact your provider. 

Prior Authorizations

iCare must authorize certain visits and procedures.  For example, if you receive a referral for an out-of-network provider, you will need to obtain a Prior Authorization.  Your provider should contact iCare for Prior Authorizations.

 

We are here to help. Call us at 1-800-777-4376 (TTY: 711) if you have questions.

 
Services Requiring Prior Authorization

 The following types of services require Prior Authorization review:

  • Admission to an inpatient hospital for medical or behavioral/mental health care
  • Admission to a subacute facility (Skilled Nursing Facility, Long-Term Acute Care Hospital, Inpatient Rehabilitation Hospital)
  • Nursing care or Therapy delivered in your home (home health care)
  • Hospice services
  • Some durable medical equipment (DME) and supplies (DMS)
  • Some medical procedures and laboratory testing
  • Outpatient physical, occupational, and speech therapy
  • Cardiac and pulmonary rehabilitation
  • Transplants
  • Referrals for second (additional) opinions
  • Referrals to non-participating providers (out-of-state or out-of-network) for all non-emergency services (emergency services do not require Prior Authorization)
  • Long-term care services under iCare’s Family Care Partnership (FCP)
  • Some dental procedures*
  • Some vision procedures*

* These requests are reviewed by delegated partners, DentaQuest or National Vision Administrators (NVA).

 

All PA Procedure Specific Listings

Note that Family Care Partnership members do not require prior authorization to receive personal care services. 

 

NOTE:  EMERGENCY SERVICES DO NOT REQUIRE PRIOR AUTHORIZATION!

 

 

 

IC200_V3 - DHS Approved 7/11/22

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