BadgerCare Plus Forms

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

• Appeal/Claim Review Request Form
• Corrected Claim Submittal Guide
• Claims Recoup/Refund Request Form

Contracting/Credentialing

• Letter of Interest Form
• Provider Addition or Change Notification Form
• Newsletter Signup Form
• Provider Update/Change Form
  

Clinical Forms

• Case / Disease Management Referral Form
• CCHP BadgerCare Plus Assessment and Treatment Plan Form
• Missed Appointment Notification Form
• Notification of Pregnancy Form
• Sterilization Form

Authorization

• BadgerCare Plus Authorization List
• BadgerCare Plus Authorization Request Form

Patient Forms

• Medicaid Breast Pump Form
• Appealing on behalf of member
• Ombudsman for grievances