Forms and Resources

 

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General Info

Get Help Service Area Maps Provider Updates Provider Newsletter Archives Provider Portal Access Authorization

Provider Manuals

Cooperative Commercial Manual Cooperative BadgerCare Plus and Medicaid SSI Manual

Network Maintenance

Facility Change Form Credentialing Form Recredentialing Form Credentialing Guidelines

Behavioral Health Forms

Behavioral Health Inpatient Admission Behavioral Health Outpatient Treatment
Day Treatment / Partial Hospitalization Discharge Information
Neuro/Psychological Testing

Claims Resources

QuickClaim User Manual

Claims Forms

ACH Credits Enrollment Available Electronic Data Partners Claims Status Inquiry 276-277
Electronic Claims Submission 837 Electronic Transfer Remittance 835 Eligibility Benefit Inquiry 270-271
Medical Claim Notes Provider Appeal

Prior Authorization Resources

High End Imaging CPT Codes
High End Imaging FAQs
Prior Authorization Guidelines

Prior Authorization Forms

Cardiac Pulmonary Rehab Certificate of Medical Necessity - Oxygen CPAP Initial Request DME Request
Home Health Request Notification for Admission Event Out of Network Referral Event PT/OT Rehab
Service Event Request Speech Therapy Request Surgical Consult for Low Back Pain TENS Evaluation