BadgerCare Plus Forms To best serve our members, Chorus Community Health Plans has pulled together a few of the key documents our participating providers will need.
Claims Forms
Contracting/Credentialing
- Letter of Interest Form
- Provider Addition or Change Notification Form
- Newsletter Signup Form
- Provider Update/Change Form
Clinical Forms
- 2017 - 2018 Synagis Season Respiratory Syncytial Virus Enrollment Form
- Case / Disease Management Referral Form
- CCHP BadgerCare Plus Assessment and Treatment Plan Form
- Missed AppointmentNotification Form
- Notification of Pregnancy Form
- Sterilization Form
Authorization
- BadgerCare Plus Authorization List
- All out-of-network providers must call clinical services at 414-266-5707 to receive a prior auth form
Patient Forms
Administrative Forms
- EDI Setup Forms:
276/277 - Claim Status
270/271 - Eligibility
277CA - Claim Acknowledgment
837 - Claim Submission - ERA Enrollment Forms:
Professional
Institutional - Emdeon Resource Library (epayment EFT can be found on the list)