Provider Orientation www.childrenscommunityhealthplan.org Or togethercchp.org
What is Together with Children s Community Health Plan? A local health plan for individuals and families Affiliated with Children s Hospital of Wisconsin Plans for Everyone not just kids Coverage sold On Exchange and Off Exchange Offers access to high-quality health care in Southeast Wisconsin An Exclusive Provider Organization (EPO)
Service Area Together with CCHP is offered in the following counties: Milwaukee Washington Ozaukee Waukesha Kenosha Racine
Infrastructure/Operations Administrative Services Agreement with UPMC Health Plan for provider service and claims. Why UPMC Health Plan they are provider owned, experience with coverage on and off Exchange.
Infrastructure/Operations CCHP is responsible for: Credentialing Case Management Complaints and Appeals Provider Contracting & Relations Quality Improvement Sales and Broker support Utilization Management
Provider Network Please note that the Together with CCHP provider network is different from our Medicaid provider network
Together ID Card - front
Together ID Card - back
Together Plan Designs
Together Benefits Bronze, Silver, Silver Standard and Gold Plans Preventive Care Coverage Pediatric Routine Vision Prescription Drug Coverage Healthy Mom, Health Baby Provider Incentive Referrals to in-network Specialists not required Care outside of the provider network is not covered with the exception of urgent and emergency care Members receive an Evidence of Coverage which is located on our web site under Members tab
Pediatric Vision Avesis (Pediatric Vision only) Annual eye exam included with no cost sharing Benefit includes lenses (contacts or glasses) and frames Customer Service: 1-844-557-2650
Prescription Drug Benefits Express Scripts Broad network of pharmacies to choose from, including Walgreens and CVS Prescription drug formulary available online Mandatory generic drug substitution Convenient mail order available $0 preventive prescriptions
Prescription Drug Benefits To see if the drug being prescribed is covered, pharmacists and clinical staff can: Call Together with CCHP Pharmacy Services at 844-201-4677 Refer to the Together with CCHP Pharmacy Benefit Guide which can be found on the web site at togethercchp.org/formulary
Together Pharmacy Benefit Guide
Notifications/Prior Authorization Prior authorization list available at www.togethercchp.org Must submit a prior authorization request online Use your current CCHP login No retro authorizations Call 1-844-450-1926 with questions or refer to the Provider Manual
Provider Portal
Registration Page
Provider Portal Login Page
Provider Portal
Together Provider Portal
Provider Forms
Claim Submission File claims timely Bill on appropriate claim forms Payment made within 30 days on clean claims Hand written claims not accepted
Claims Submission Electronic Claims Preferred: Please submit claims electronically to Together with CCHP EDI Payer ID#: 251CC Electronic Remittance Advice (ERA) and Electronic Fund Transfers (EFT) are available forms available on web site Paper Claims: Mailing Address: Together with CCHP P.O. Box 106013 Pittsburgh, PA15230-6013
Where to call with claims questions? For questions regarding claims and Explanation of Payment (EOP), please contact Together with CCHP Provider Service at 1-844-202-0117
Claim Appeals Please call Provider Services to discuss claim denials prior to submitting a written appeal. To file a written appeal: Complete the Together with CCHP Provider Appeal Form, which is available on the Provider Forms page at togethercchp.org Submit the form, along with copies of any supporting documentation to: Together with CCHP ATTN: Appeals Department P.O. Box 1997, MS 6280 Milwaukee, WI 53201-1997
Grace Period If member is terminated due to lack of payment Claims are paid for days 1-30 Claims paid during days 31-90 days will be recouped
Provider Updates For Provider demographic changes complete the Provider Update/Change Form available on our web site. Examples: TIN change Address change Billing address change
Together with CCHP Reference Guide
Email & Contact Information Send us your email and contact information for future updates and news. Send emails to sbautch@chw.org
Questions?