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icon 2010 Formulary
icon 2010 Comprehensive Formulary
A list of covered drugs representing the prescription therapies believed to be a necessary part of a quality program. 

icon 2010 Step Therapy, Prior Authorization and Quantity Limits

Prescription Drug Grievance, Appeal and Coverage Determination Processes

Grievances, Appeals and requests for Coverage Determinations and Exceptions may be
submitted in writing or by contacting us by telephone.

In the event you wish to file a Grievance or Appeal, or request a Coverage Determination or Exception, we encourage you to contact Customer Service right away for assistance.

If you prefer to submit your request in writing, Grievances and Appeals may be submitted by simply sending us a letter describing your concern. Requests for Coverage Determinations or Exceptions may be submitted by printing the icon Medicare Part D Coverage Determination and mailing the completed form to Care Wisconsin.

To appoint an individual to represent you in the Grievance, Appeal and Coverage Determination process, you will need to complete the icon Appointment of Representative.

You can find brief definitions of a Grievance, Appeal, Coverage Determination and Exception in the icon Glossary of Terms. Definitions also are included in Section 15 of the Evidence of Coverage you received at the time of your enrollment.

Detailed information regarding your Grievance and Appeal rights and about Coverage Determinations may be found in Section 12 of the Evidence of Coverage for your plan. You received a printed copy of your Evidence of Coverage at the time of your enrollment. You also may access the Evidence of Coverage for your plan through the link on this Web site.

Partnership Customer Service
Members in need of assistance may contact us, Monday-Friday, 8 a.m. to 4:30 p.m., CT.
Call: (608) 240-0035 or 1-800-963-0035
WI Relay 711
Fax: (608) 241-5230

Provider Services
Providers should call the Provider Help Desk at (608) 245-3053 or 1-877-496-3858.
Email to: This E-mail address is being protected from spam bots, you need JavaScript enabled to view it  

Mail written Grievance and Appeal to:
Care Wisconsin Health Plan
Attn: Grievances and Appeals
2802 International Lane
P.O. Box 14017
Madison, WI 53708-0017

Mail written request for a Coverage Determination to:
Care Wisconsin Health Plan
Attn: Coverage Determinations
2802 International Lane
P.O. Box 14017
Madison, WI 53708-0017

 

 
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