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Transition Your Care

We are happy you have selected Group Health Cooperative of South Central Wisconsin (GHC-SCW) as your health care insurance partner. It is our goal to ensure all new members enjoy a smooth transition when joining the GHC-SCW family. Our Care Management and Member Services Teams are available to answer any questions you may have. 

We ask new members to follow these steps to ensure a smooth transition of care to GHC-SCW.

1.Please review the following documents to help with your transition of care.

2. Complete the Transition of Care Form: ​​In English and En E​spañol​


At GHC-SCW, we know that receiving care at a convenient location is important. That is why we offer six GHC-SCW Primary Care clinics and two specialty care clinics that are located around the Madison area. We also work with a variety of providers within Dane County and the surrounding counties. Click here to view our Provider Maps and Directories.

If you have questions about transitioning your care to GHC-SCW, call Care Management at (608) 257-5294 or (800) 605-4327 
Ext. 4514, and a member of the Care Management Team will assist you.

​ ​​ 3. Please Upload your Pdfs Here: (Save each form individually then select all PDf's to upload at one time​)​

Referral Request

Some services require a prior authorization before receiving them. Members must receive an approval letter from the GHC–SCW Care Management Department before receiving these services. If you complete the service without first obtaining an approval letter from GHC–SCW Care Management, you may be responsible for full payment of the services provided.

The GHC-SCW Care Management Team will evaluate the order to determine if it is a covered benefit and review it against national care guidelines to determine if care is medically necessary.

Most referral decisions will be made within four or five business days. Up to 15 days are allowed for review if additional information is needed by the Care Management Team and/or the Medical Director or Physician Reviewer.

 

Approval Letter

GHC–SCW approves services or supplies based on the information that is available at the time of the approval/denial decision. Approval does not guarantee a member's eligibility or benefits under his or her health plan. It is the responsibility of the member to know their deductible, co–pay or co–insurance amounts that apply to specialty services.

If your request is denied, you will receive a letter in the mail explaining the reason for the denial and your member appeal rights.

 

Member Self-Referral

The GHC-SCW Member Self-Referral program allows members to schedule appointments without prior authorization for the following services:

  • Emergency conditions at an In-Plan facility
  • Behavioral Health/Mental Health outpatient therapy at any In-Plan facility
  • Psychiatric outpatient care at any In-Plan facility
  • Alcohol and drug addiction services at any In-Plan facility
  • OB/GYN at an In-Plan facility
  • Eye examinations at GHC-SCW
  • Chiropractic care at GHC-SCW
  • Podiatry at GHC-SCW
  • Physical therapy/occupational therapy at GHC-SCW

Please check your Benefits Summary for full coverage details. The specialty care you receive must be within your network. These exceptions do not apply to PPO Plan members. Contact the GHC-SCW Care Management Department if you have questions regarding the referral/prior authorization process at (608) 257-5294.