This is the place for providers to find Prior Authorization-related forms and other documents. You can also find them on the Provider Documents page.
To locate a Medicare Advantage coverage policy referenced in a letter you received, please refer to Humana's Medical and Pharmacy Coverage Policies; iCare is a subsidiary of Humana, and coverage policies are located on Humana's Medical and Pharmacy Coverage Policies page. Enter the number or name of the policy referenced in your letter in the keyword search box on this page.
iCare Health Plan also utilizes Care Guidelines to determine medical necessity for the plans that we manage. The Guidelines are the protected intellectual property of MCG. iCare Health Plan is not able to distribute them without the permission of MCG. MCG has provided a tool that allows iCare Health Plan members and prospective members to view relevant MCG guidelines, however you will not be able to print them.
Follow the instructions below to access the MCG Guidelines:
iCare has prepared some FAQs for Medicare Advantage coverage policies.
Comprehensive Formulary
Part D Prior Authorization Criteria
Step Therapy Prior Authorization Criteria
Results Updated
27 Results Listed
Independent Care Health Plan (iCare) must be notified of all inpatient stays within one (1) business day of the admission.
Holistic Home Health Care Referral Form for Personal Needs Assessment
The Personal Care Screening Tool was developed to assist providers in determining the number of units to request for PA (prior authorization) of medically necessary personal care services that are to be provided by a PCW (personal care worker). Here is the form in PDF format.
As a new or continuing member in our plan you may be taking drugs that are not on our formulary. Or, you may be taking a drug that is on our formulary but your ability to get it is limited. For example, you may need a prior authorization from us before you can fill your prescription.
Guidance for Providers and Members about In Lieu of Services regarding Medically Tailored Meals
ForwardHealth requires persons who are requesting authorization for personal care (PC) service to complete and submit the Personal Care Screening Tool. Here are instructions to do so.
Providers use this updated form to request a prior authorization
COVID 19 Webinar for Providers to understand iCare's Prior Authorization guidelines related to COVID claims
iCare Urine Drug Screen Provider Education. As a standard benefit, all iCare members will receive 6 urine drug screens per year. For additional information about prior authorization, read this information document.
iCare Urinary Drug Screen prior authorization policy provides an overview of the minimum requirements to complete a urine drug screen (UDS) prior authorization (PA) request for Medicare, Medicaid, and BadgerCare Plus members.
DHS Form: F02717-Electronic Visit Verification-Live-In Worker ID form
3/31/2020 Update from iCare Prior Authorization to Personal Care Workers and Home Health Care Providers.
3/31/2020 Update from iCare Prior Authorization to providers including Subacute care, Long Term Acute Care (LTAC), Skilled Nursing Facilities (SNF) and Inpatient Rehabilitation facilities (IRF) providers.
This document answers frequently asked questions by providers about Behavioral Health and AODA as related to claims and prior authorization for treatment programs received by iCare members.
In-home meal service is provided by iCare as a supplemental Medicare benefit to members immediately following surgery or an inpatient hospital stay, for a temporary duration when ordered by a practitioner.
Remittance Reason Codes provide additional explanation for a claim
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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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