Blank Provider Add, Change, Term (PACT)*

Case Management Referral*

Claim Adjustment / Review Request*

Drug Prior Auth Forms

Behavioral Health Outpatient Treatment Plan Request*

Psychiatrist Outpatient Treatment Request*

Standard Prior Authorization for all requests*

BadgerCare Behavioral Health Forms
Service Initiation

Service Authorization Request

Termination of Treatment

BadgerCare Provider Manual

BadgerCare Quick Reference Guide

Provider Manual
The provider manual is a source of readily available information regarding the administration of Physicians Plus Insurance for participating providers and their office staff.

• A. INTRODUCTION SECTION
  A1.1 Introduction
  A2.1 How to Contact Physicians Plus Insurance
• B. PRODUCTS AND BENEFIT PLANS SECTION
  B1.1 Benefit Plans
  B2.1 Exclusions and Limitations
• C. MEMBERSHIP SECTION
  C1.1 Membership
  C2.1 Sample ID Card
  C3.1 Member Rights & Responsibilities; Appeals Process
  
• D. PHYSICIAN SERVICES/PLAN PROVIDERS SECTION
  D1.1 Physician Services
  D2.1 Role of the Primary Care Physician
  D3.1 Role of the Specialist
  D4.1 Privacy and Confidentiality of PHI
  
• F. PRIOR AUTHORIZATION OF PROCEDURES SECTION
  F1.1 Prior Authorization Definition
  F2.1 Services Requiring Prior Authorization
  F3.1 Prior Authorization Form Instructions ( * download the form in the "Forms" section above)
  F4.1 Provider Responsibility
  F6.1 Durable Medical Equipment
• G. UTILIZATION MANAGEMENT SECTION
  G1.1 Utilization Management
  G2.1 Concurrent Review and Discharge Planning
  G3.1 Case Management
  G4.1 NursePlus
• H. EMERGENCY/OUT-OF-AREA SECTION
  H1.1 Emergency Care
  H2.1 Out-of-Area Services
  H3.1 Urgent Care
• I. BEHAVIORAL HEALTH/CHEMICAL DEPENDENCY (BH/CD) SECTION
  I1.1 Prior Authorization Process
  I2.1 UW BH Treatment Request Forms
  I6.1 Behavioral Health Benefits
• J. PHARMACY SERVICES SECTION
  J1.1 Pharmacy Services Department
  J2.1 Drug Formulary
  J3.1 Drug Benefit
  J4.1 Tobacco Cessation
• K. CLAIMS PROCEDURES SECTION
  K1.1 Claim Form Requirements
  K2.1 Payment of Claims
  K2.2 GO-TO
  K3.1 Coordination of Benefits (COB)
  K4.1 Subrogation
  K5.1 Worker’s Compensation
  K6.1 Surgical Assistant Reimbursement Schedule
• L. QUALITY IMPROVEMENT SECTION
  L1.1 Quality Management
  L3.1 Access to Care
  L4.1 Credentialing and Recredentialing of Practitioners
  L5.1 Medical Records Documentation/Auditing
  L6.1 Review of P+ Insurance Provider Facilities
  
• M. PROVIDER CONTRACT PROVISIONS SECTION
  M1.1 Provider Contract Provisions
  M2.1 Provider Appeals Process
• N. PROVIDER NETWORK MANAGEMENT SECTION
  N1.1 Provider Network Management