Providers

PDF Resources

Listing of CMS approved iCare Medicare publications, Medicaid publications, third-party preventive health brochures.

• Abridged Formulary/iCare Medicare Plan 2012
• Abridged Formulary/iCare Partnership 2012
• Annual Notice of Change (ANOC)/iCare Medicare Plan 2012
• Annual Notice of Change (ANOC)/iCare Partnership 2012
• Anti-Smoking Quit Line (English)
• Anti-Smoking Quit Line (Spanish)
• Caregiver Background Check Policy
• Claim Form LTC Professional Services - Trizetto
• Claim Form LTC Residential Services - Trizetto
• CMS Appointment of Representative Form
• Comprehensive Formulary/iCare Medicare Plan 2012
• Comprehensive Formulary/iCare Partnership 2012
• Emergency Room Brochure
• Enrollment Form/iCare Medicare Plan 2012
• Evidence of Coverage/iCare Medicare Plan 2012
• Evidence of Coverage/iCare Partnership 2012
• Family Care Partnership Provider Application
• FCP Provider Reference Manual
• First Tier, Downstream and Related Entities Fraud
• Formulary Change Notice (iCare Medicare Plan)
• Formulary Change Notice (iCare Partnership)
• HCFA Claim Required Fields
• Limited English Proficiency Policy/Procedures
• LIS Premium Summary Sheet 2012
• Member Handbook/BadgerCare Plus Core Plan
• Member Handbook/iCare Medicaid SSI
• Member Recertification Reminder/BadgerCare Plus Core
• Notice of Privacy Practices
• Part D Coverage Determination Request Form
• Part D Prior Authorization Criteria/iCare Medicare Plan 2012
• Part D Prior Authorization Criteria/iCare Partnership 2012
• Part D Redetermination Request Form
• Pharmacy Listing/iCare Medicare Plan 2012
• Pharmacy Listing/iCare Partnership 2012
• Plan Comparisons/iCare Partnership 2012
• Power of Attorney brochure
• Primary & Acute Care Information Form
• Prior Authorization List 4/19/12
• Prior Authorization List 4/19/12 pdf
• Program Brochure/Hmong/iCare Medicaid SSI
• Program Brochure/iCare BadgerCare Plus
• Program Brochure/iCare Medicaid SSI
• Program Brochure/iCare Partnership
• Program Brochure/Spanish/iCare Medicaid SSI
• Program Overview (Spanish)/iCare Medicaid SSI
• Program Overview (Spanish)/iCare Partnership
• Provider Directory/iCare Medicaid SSI-BadgerCare Plus_Expansion Counties
• Provider Directory/iCare Medicaid SSI-BadgerCare Plus_Original Counties
• Provider Directory/Pharmacy Directory/iCare Medicare Plan Expansion Counties 2012
• Provider Directory/Pharmacy Directory/iCare Medicare Plan Original Counties 2012
• Provider Information Form (other than Partnership Program)
• Provider Reference Manual 2012
• Provider/Pharmacy Directory - iCare Partnership 2012
• Recertification Reminder (flyer)/BadgerCare Plus
• Self-Directed Supports Program Overview/iCare Partnership
• Step Therapy Prescription Drug Criteria/iCare Medicare Plan 2012
• Step Therapy Prescription Drug Criteria/iCare Partnership 2012
• Summary of Benefits/iCare Medicare Plan 2012
• Summary of Benefits/iCare Partnership 2012
• Transition Process
• UB Claim Required Fields
• Value to the Family