Medical Claims Processing
Contact TMG Health, Inc. at (866) 412-9898 or mail claims to: CWHP, P.O. Box 600, Dunmore, PA 18512.
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.
2009 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.
2009 Care Wisconsin Quantity Limit Restrictions
2009 Care Wisconsin Step Therapy Restrictions
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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