Before submitting your authorization request, please review the most recent list below for exclusions and other important information. For the most up to date configuration please click the "View Coverage and Limitation List" hyperlink below:
View the 2024 Coverage and Limitation List
Achieved website list(s) from 2023 can be referenced by clicking the previously updated versions of the list below:
- For Date of Service 11/8/23 to 11/16/23
- For Date of Service 11/16/23 to 12/5/23
- For Date of Service 12/6/23 to 12/21/23
- For Date of Service 12/21/23 to 12/31/23
NOTE: The CCHP BadgerCare Plus No Prior Authorization Required List has been removed from our website. Please refer to the ForwardHealth Max Fee Schedule to determine if a code is covered for BCSP or the CCHP prior authorization list to determine if a code requires an authorization. If the code is on the ForwardHealth Max Fee Schedule and is not on the CCHP prior authorization list, then the code is no prior authorization.
Submit Authorizations Online
Network providers should submit inpatient admission notifications and prior authorization requests online using the Guiding Care authorization portal.
Out-of-network providers must call CCHP's Clinical Services department at 877-227-1142 (option 2) for authorization requests. The Guiding Care authorization tool gives network providers the online capability to:
- Quickly submit an authorization request
- Receive a reference number, an approval or review notification immediately
- Provide concurrent review information for inpatient admissions
Questions?
For questions or assistance with your authorization request, call:
Chorus Community Health Plans - Clinical Services Department
Toll-free: 877-227-1142, option 2
Local: (414) 266-5707
Affirmative Statement
Chorus Community Health Plans (CCHP) wants its members to get the best possible care when they need it most. To ensure this, we use a auto authorization process, which is part of our Utilization Management (UM) program. UM decision-making is based only on appropriateness of care and service, and existence of coverage. CCHP does not specifically reward practitioners or other individuals for issuing denials of coverage. Financial incentives for UM decision makers do not encourage decisions that result in underutilization.