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 />
Physician<br />
Visits/Professional<br />
Services<br />
<strong>BadgerCare</strong> <strong>Plus</strong> Standard<br />
Plan and <strong>Medicaid</strong> <strong>SSI</strong><br />
Full coverage including<br />
laboratory and radiology<br />
with no copayment.<br />
<strong>BadgerCare</strong> <strong>Plus</strong><br />
Benchmark Plan<br />
Full coverage with a $15.00<br />
copayment per visit.<br />
Covered services include:<br />
Office visits (including urgent<br />
care), second surgical<br />
opinions, consultations,<br />
evaluation and management<br />
services, outpatient surgical<br />
services and telemedicine.<br />
Specialists have the same<br />
copayments as other<br />
providers.<br />
<strong>BadgerCare</strong> <strong>Plus</strong> Core Plan<br />
Full coverage, including<br />
laboratory and radiology<br />
with no copayment.<br />
No copayment for<br />
emergency services,<br />
preventive care, anesthesia,<br />
or clozapine management.<br />
Podiatric Services<br />
Prenatal<br />
Care/Maternity<br />
Preventive Services<br />
Private Duty Nurses<br />
Reproductive <strong>Health</strong><br />
Full coverage with no<br />
copayment.<br />
Full coverage with no<br />
copayment. Includes<br />
Prenatal Care Coordination<br />
(PNCC) and preventive<br />
mental health and<br />
substance abuse screening<br />
and counseling for women<br />
at risk of mental health or<br />
substance abuse problems.<br />
Full coverage with no<br />
copayment.<br />
Full coverage with no<br />
copayment.<br />
Full coverage, excluding<br />
infertility treatments,<br />
surrogate parenting and the<br />
reversal of voluntary<br />
sterilization. No copayment.<br />
Birth control pills are<br />
covered through your<br />
Forward <strong>Health</strong> ID card.<br />
Please show this card to<br />
the pharmacy.<br />
No copayment for<br />
emergency services,<br />
preventive care, anesthesia<br />
or clozapine management.<br />
Full coverage with a $15.00<br />
copayment per visit.<br />
Full coverage with no<br />
copayment. Includes<br />
Prenatal Care Coordination<br />
(PNCC) and preventive<br />
mental health and<br />
substance abuse screening<br />
and counseling for women<br />
at risk of mental health or<br />
substance abuse problems.<br />
Full coverage with no<br />
copayment. Includes bone<br />
mass, colorectal screening,<br />
mammograms, pap smears,<br />
breast exams and prostate<br />
screenings.<br />
Not Covered.<br />
Full coverage, excluding<br />
infertility treatments,<br />
surrogate parenting and the<br />
reversal of voluntary<br />
sterilization. No copayment.<br />
Birth control pills are<br />
covered through your<br />
Forward <strong>Health</strong> ID card.<br />
Please show this card to the<br />
pharmacy.<br />
<strong>Health</strong> education for<br />
members with asthma,<br />
diabetes or hypertension.<br />
Full coverage with no<br />
copayment. A prior<br />
authorization is needed if<br />
podiatric and digital surgery<br />
is not done in the doctor’s<br />
office.<br />
Not Applicable<br />
Full coverage with no<br />
copayment for preventive<br />
care.<br />
Not Covered.<br />
Family planning services<br />
provided by family planning<br />
clinics will be covered<br />
separately under the Family<br />
Planning Waiver program.<br />
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