Providers
Prior Authorization
Inpatient Notification Procedure: All elective inpatient admissions must be called into iCare within five business days prior to admission by the physician's office. This allows iCare to initiate early discharge planning. Hospitals must ALWAYS notify iCare of all inpatient admissions, elective or emergent, by the following business day.
- Fax: 414-231-1075
Prior Authorization Forms
- General Prior Authorization form
- Home Health/Personal Care Worker
- Medicare Part D Coverage Determination Form
- Medication Request Form - Partnership Medicaid
- Therapy
Services Requiring Prior Authorization
All requests must be submitted by the physician to iCare no less than five business days (or as soon as possible) prior to the procedure.
- Air Transport
- All Mental Health & Substance Abuse Services
- Home Health (requires 485 form)
- Inpatient Admission with a pre-op day or one-day length of stay
- Inpatient Admission to SNF, LTAC, Rehab and Hospice
- Orthotics/Prosthetics/Hearing Aides
- Out of Network Providers/Procedures
- Pain Management Program Evaluation
- Synagis Injection (For BadgerCare Plus only)
- Therapy (PT, OT, Speech, Cardiac, Pulmonary)
- Wound Care Vacuum Systems
Inpatient/Outpatient Procedures Requiring Prior Authorization
- Abdominoplasty/other Lipectomies
- Augmentation/Reduction Mammoplasty
- Brain Mapping, Grid Placement, Stereotaxis
- Botox Injections
- Capsule Endoscopy
- Circulating tumor cell markers
- Cochlear implant
- Cosmetic eye procedures: Brow ptosis, Blepharoplasty, correction of lid retraction
- Chemical peel/keloids
- Dermabrasion/Scar abrasion or revision
- Gastric banding, Gastrojejunostomy, Gastric Bypass
- Genetic testing (includes molecular testing and probes and cytogenetic testing)
- Intracranial neurostimulators
- Laparoscopic gastric procedures
- LeForte procedures
- Mastectomy for Gynecomastia
- Nerve stimulators
- Otoplasty for protruding ears
- Pain management procedures
- Removal of breast implant(s)
- Rhinoplasty and/or Septoplasty
- Rhytidectomy
- Temporomandibular Joint surgeries
- Transplant evaluation and requests
- Trigger point injections
- Uvulopalatopharyngoplasty (UPPP)
- Varicose vein procedures
- Wearable/External cardiac defibrillator (Life Vest)
Please note that services and authorizations are subject to change.
Referral Management
Referrals are required only for the specialties of oral surgery and plastic/reconstructive surgery. The PCP must generate all referrals to specialists. Upon receipt of all required information, urgent referrals are processed within one (1) business day of receipt and two (2) business days for all other referrals.
- Fax: 414-231-1026
Provider Resources
PDF Resources
- Abridged Formulary/iCare Medicare Plan 2010
- Abridged Formulary/iCare Partnership 2010
- Anti-Smoking Quit Line (English)
- Anti-Smoking Quit Line (Spanish)
- BadgerCare Plus Core Member Recertification Reminder
- CMS Appointment of Representative Form
- Community Activity Facilities and Programs
- Comprehensive Formulary/iCare Medicare Plan 2010
- Comprehensive Formulary/iCare Partnership 2010
- Coverage Determination Request Form
- Emergency Room Brochure
- Enrollment Form/iCare Medicare Plan 2010
- Evidence of Coverage (EOC)/Member Handbook - 2010 iCare Partnership
- Evidence of Coverage/ANOC/iCare Medicare Plan 2010
- Fraud, Waste and Abuse Compliance Training 2010
- Greivance and Appeals Process/iCare Partnership 2010
- iCare BadgerCare Plus Program Brochure
- iCare BadgerCare Plus Program Brochure/Hmong
- iCare Medicaid SSI Program Brochure
- iCare Medicaid SSI Program Brochure/Hmong
- iCare Medicaid SSI Program Brochure/Spanish
- iCare Medicare Plan 2010 Program Brochure
- iCare Medicare Plan 2010 Program Brochure/Spanish
- iCare Road to Independence Video Challenge Package
- iCare/Independent Care Health Plan Scholarship
- Letter of Medical Necessity
- Limited English Proficiency Policy/Procedures
- LIS 2010 Premium Summary Sheet
- Medicare Part D Coverage Determination Form
- Medication Request Form - Partnership Medicaid
- Member Handbook/iCare BadgerCare Plus
- Member Handbook/iCare BadgerCare Plus Core Plan
- Member Handbook/iCare BadgerCare Plus Core Plan/Spanish
- Member Handbook/iCare BadgerCare Plus/Hmong
- Member Handbook/iCare BadgerCare Plus/Spanish
- Member Handbook/iCare Medicaid SSI
- Member Handbook/iCare Medicaid SSI/Spanish
- Notice of Formulary Change/iCare Medicare SNP 2010
- Notice of Formulary Change/iCare Partnership 2010
- Over-the-Counter Drug Program Catalog/iCare Medicare Plan 2010
- Over-the-Counter Drug Program Catalog/iCare Medicare Plan 2010/Spanish
- Over-the-Counter Drug Program Catalog/iCare Partnership Plan 2010
- Parental Consent Form
- Partnership Program Brochure/iCare 2010
- Pharmacy Directory/iCare Medicare Plan/iCare Partnership 2010
- Pharmacy Listing/iCare Medicare Plan 2010
- Pharmacy Listing/iCare Partnership 2010
- Plan Comparison brochure/iCare Partnership 2010
- Power of Attorney brochure
- Prior Authorization Criteria/iCare Medicare SNP 2010
- Prior Authorization Criteria/iCare Partnership 2010
- Privacy Statement
- Provider Directory Supplement/BadgerCare Plus
- Provider Directory/iCare BadgerCare Plus-Medicaid SSI
- Provider Directory/iCare BadgerCare Plus-Medicaid SSI/Spanish
- Provider Directory/iCare Medicare Plan 2010
- Provider Directory/iCare Partnership 2010
- Provider Manual
- Provider Newsletter Fall 2008
- Report to the Community
- Road to Independence Video Challenge Flyer
- Self-Directed Supports Brochure/iCare Partnership 2010
- Self-Directed Supports Guide/iCare Partnership 2010
- Step Therapy Prescription Drug Criteria/iCare Medicare SNP 2010
- Step Therapy Prescription Drug Criteria/iCare Partnership 2010
- Summary of Benefits/iCare Medicare Plan 2010
- Summary of Benefits/iCare Partnership 2010
- Transition Process
Call 1-800-777-4376 (TTY: 1-800-947-3529), from 8:00 a.m to 8:00 p.m.,
7 days-a-week, for further information about iCare.