Medical Claims Processing
For questions about delayed claims payments, click here.

TriZetto, Inc, a third party administrator (TPA) receives and processes your claims (bills/invoices) for services provided to members in our Family Care and Family Care Partnership programs.  Please submit drug claims to PharmaStar.

• Use your Provider ID#.
• Mail your claims directly to TriZetto. 

TriZetto - Care Wisconsin
P.O. Box 853924
Richardson, TX  75085-3924

All Providers are asked to use a standard claim form (CMS 1500, UB04) or a template approved by Care Wisconsin for submitting bills, invoices or claims.  All bills, invoices and claims must have the correct procedure or revenue codes indicated.  If you are not using such a form or are not properly coding your claims, call our Provider Help Desk to see if you need to change your billing format.  Failure to do so may cause payment delays.

Our intention is to pay your invoice or claim within 30 days after receiving a complete and accurate claim for an eligible member. Payment will be mailed to you. Therefore you will not be able to pick up payment at a local office. Payment will be for all charges related to authorized services you provided to a member in the previous month.

Pharmacy Claims Processing
Contact PharmaStar at (715) 552-4320 or (888) 298-7770.

Clinical Practice Guidelines
Care Wisconsin has adopted the use of published texts for its Clinical Practice Guidelines—standards for managing specific diseases or syndromes that are evidence-based. The strongest available information on the efficacy of treatment is used to develop standards of care that result in the highest quality of care.

These references are posted for your convenience:

• Reuben D. B., Heer K. A., Pacala J. T., et al. (2006). 2007-2008 Geriatrics At Your Fingertips, 9th Edition. American Geriatrics Society, New York, New York. (Also available online at www.geriatricsatyourfingertips.org)
• Beizer J. L., et al. (2005). Lexi-Comp's Geriatric Dosage Handbook, 11th Edition. Lexi-Comp, Hudson, Ohio.
• Guide to Clinical Preventive Services, 2007 — Recommendations by the U.S. Preventive Services Task Force of the U.S. Department of Health and Human Services.         

 2010 Formulary
 2010 Comprehensive Formulary
A list of covered drugs representing the prescription therapies believed to be a necessary part of a quality program.  For information on our Prescription Drug Grievance, Appeal and Coverage Determination Processes, click here.

 2010 Step Therapy, Prior Authorization and Quantity Limits

Member Materials
To view and download member materials, including the Provider Directory, Summary of Benefits and Evidence of Coverage, click here.

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