BadgerCare Plus & Medicaid SSI Provider Manual - Group Health ...
BadgerCare Plus & Medicaid SSI Provider Manual - Group Health ...
BadgerCare Plus & Medicaid SSI Provider Manual - Group Health ...
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<strong>BadgerCare</strong> <strong>Plus</strong> & <strong>Medicaid</strong> <strong>SSI</strong> <strong>Provider</strong> <strong>Manual</strong> - GHC of Eau Claire May 2012<br />
Service<br />
Lab and Radiology<br />
Services (diagnostic<br />
or medically<br />
necessary)<br />
Mental <strong>Health</strong> and<br />
Substance Abuse<br />
Inpatient<br />
Mental <strong>Health</strong> and<br />
Substance Abuse<br />
Outpatient<br />
Mental <strong>Health</strong> and<br />
Substance Abuse-<br />
Day Treatment<br />
Nursing Home/Skilled<br />
Nursing<br />
Nutrition Therapy<br />
(Enteral)<br />
<strong>BadgerCare</strong> <strong>Plus</strong> Standard<br />
Plan and <strong>Medicaid</strong> <strong>SSI</strong><br />
Full coverage with no<br />
copayment.<br />
Full coverage with no<br />
copayment.<br />
Full coverage with no<br />
copayment.<br />
Full coverage with no<br />
copayment.<br />
Full coverage with no<br />
copayment.<br />
Full coverage with no<br />
copayment.<br />
<strong>BadgerCare</strong> <strong>Plus</strong><br />
Benchmark Plan<br />
Full coverage with no<br />
copayment for laboratory<br />
and radiology services<br />
performed in a clinic setting.<br />
$50.00 copayment per<br />
hospital stay for mental<br />
health and substance<br />
abuse. Services provided<br />
during inpatient stay:<br />
Inpatient hospitalization<br />
copayment applies.<br />
$15.00 copayment per visit.<br />
Subject to only one<br />
copayment for an evaluation<br />
& psychotherapy procedure<br />
billed on the same day.<br />
Electroshock procedure,<br />
pharmacologic management<br />
or lab tests.<br />
$10.00 copayment per day.<br />
Adult, child and adolescent<br />
mental health day treatment.<br />
Adult, child and adolescent<br />
substance abuse day<br />
treatment.<br />
Full coverage with a limit of<br />
30 days per enrollment year<br />
in a nursing home.<br />
Coverage limitations apply<br />
to the following services:<br />
disposable medical<br />
supplies, durable medical<br />
supplies, therapies (PT, OT,<br />
SLP). Members residing in<br />
a nursing home are not<br />
subject to copayments for<br />
nursing home services.<br />
Members are subject to<br />
copayment for services they<br />
receive during their stay if<br />
the services require<br />
copayment. Bed hold days<br />
are not covered.<br />
Not Covered.<br />
<strong>BadgerCare</strong> <strong>Plus</strong> Core Plan<br />
Full coverage with no<br />
copayment.<br />
Not Covered.<br />
Full coverage with no<br />
copayment limited to mental<br />
health therapy services<br />
provided by a psychiatrist<br />
only.<br />
Not Covered.<br />
Not Covered.<br />
Not Covered.<br />
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