Community Care Home   Community Care on Facebook  Community Care on LinkedIn   

Contact Us At:

1-866-992-6600

Provider News

Pay for Performance (P4P)

During the third quarter of this year, DHS is conducting a Member Satisfaction Survey and will tie MCO payment to their performance on the satisfaction surveys.  Surveys will be sent to approximately 30,000 MCO participants throughout the state of Wisconsin.  We are expecting that about half of Community Care members will receive this survey.  Please encourage CCI members and guardians to watch for surveys in the mail and to complete them.  DHS appreciates your assistance in helping to provide feedback.  Please note, the return address on the survey does not identify Community Care but does identify DHS and UW Survey Center.  Here is what the survey envelope looks like:

Wisconsin Department of Health Services
C/O UWSC
Sterling Hall, Room B607
475 North Charter Street
Madison, WI 53706-1507 

Requests for Proposal

Community Care, Inc. is seeking interested providers to work with Community Care to create a supportive environmental and meaningful life experiences for individuals. Please click below for the following opportunities. If there are none, please check back frequently for updates.

Community Care periodically issues Requests for Proposals (RFPs). Please check back often for any current RFPs. 

Request for Proposal, December 11, 2018

Provider Advisory Committee

Providers are encouraged to share information, input and feedback with us to create a better partnership and continue to raise the standard in care. You can reach our Provider Management Department by calling 866-937-2783 or emailing contractinquiries@communitycareinc.org. Suggested agenda topics for meetings can be addressed to Provider Advisory Committee members and minutes from those meetings are published in Provider Bulletins and on Community Care's website.

Committee Members
  • Dan Drury, Options for Community Growth
  • April Juett, AJ's Living
  • Bill Gudwer, Limitless Possibilities
  • Norris Jones, Southern Hope Homes
  • Victor Reale, Atrium
  • Krista McCook, Mosaic
  • Mike Nardi, Southport Transport
  • Dennise Lavrenz, MCFI
Committee Meeting Minutes Provider News - September, 2013 Provider News - May, 2013 Provider News - August, 2012

NOTICE:  Change to Authorization Policy – 11/1/2018:

Beginning November 1st, 2018 Community Care, Inc. will no longer require prior authorization for services where Medicare or other non-Medicaid insurance providers  are the primary insurer and Family Care is responsible only for deductibles , coinsurance or cost shares. This includes most DME, therapy, mental health services, and Medicare SNF Part A stays where Family Care acts as the beneficiary’s Medicaid replacement plan. 

Community Care, Inc. may still choose to send an authorization or communicate in other ways with providers of these services; however, this does not imply the service will be approved without submission to Medicare or other liable parties first unless that is explicitly stated on an authorization. Claims approved by another insurer will not require an authorization for payment of deductibles and co-insurances or cost shares, but will still be subject to other claim processing standards, and claims may be denied if the other insurance does not approve payment. Per 1902(a)(25) of the Social Security Act, Medicaid is the payer of last resort meaning that Medicaid will only pay for services after all liable insurers have met legal obligations to pay.

Providers must work directly with the member’s physician to obtain supporting documentation and prior authorization required by the member’s primary insurance.  If it is not possible to obtain coverage from the primary payer, providers must provide an ABN (Advance Beneficiary Notification of Non-Coverage) or other suitable documentation that the beneficiary does not meet coverage criteria to IDTS (Interdisciplinary Team Staff) prior to the delivery of any equipment or service. Community Care will not pay primary for benefits covered by a member’s primary insurance when the denial reason is lack of sufficient paperwork or without prior authorization by IDTS. When a primary insurance denies coverage, Community Care, Inc. will not approve payment unless we have provided an authorization in advance to the provider indicating that we will pay as the primary insurer.

This new coverage policy applies only to Family Care members for benefits covered by Medicare or other primary insurance at the time of service beginning November 1st 2018. There are no changes to the coverage policy for Medicaid only Family Care members or benefits not covered by Medicare or another primary insurer. These services will continue to require prior authorization as a condition of payment.

Home   |   Who We Are   |   Members & Families   |   For Providers   |   Careers   |   Consulting Services   |   Contact Us



 Corporate Headquarters: 205 Bishops Way, Brookfield, WI 53005
Phone: (414) 231-4000 Toll Free: 1-866-992-6600 TTY: Call the Wisconsin Relay System at 711
Help in Other Languages
 
© 2014-2017, Community Care, Inc. - All Rights Reserved   |   Privacy Policy   |   Terms of Use