Provider Resource Documents
Developed to serve as a reference for our participating Practitioners and Providers.
The purpose of the manual is to inform you about GHC-SCW, our policies and procedures and our Quality Improvement program and initiatives.
The manual is a quick reference where you can find answers to frequently asked questions.
Provider Documents
The following documents are made available for all plan providers and practitioners as a reference of key GHC-SCW programs and/or policies and procedures to provide additional information about the services and/or processes of the health plan.
- Appeal or Grievance Process
- Provider Appeal Form
- Credentialing and Re-Credentialing Policy
- Guidelines for BadgerCare Plus Claim Appeals
- Member Rights and Responsibilities Policy
- Peer Review Policy
- Pharmaceutical Management Program Policy
- Population Health Management
- Prior Authorization Guidelines
- Request for Ongoing Behavioral Health Services Form (Online)
- Request for Ongoing Behavioral Health Services Form (Printable)
- Utilization Management Program
- Provider Orientation Manual
- EFT Authorization Form
BadgerCare Plus/WI Medicaid Provider Documents
Guidelines for BadgerCare Plus Claim Appeals
Additional Request Forms
To send electronic claims to GHC-SCW you must complete the setup form with our clearinghouse, Change Healthcare.
Steps to enroll through Change Healthcare:
- Click this link.
- Search for 39167 (GHC-SCW’s number) to get to the Change Healthcare form below and send it to Change Healthcare.
- Scroll down to find the right form. It should be called “GROUP HEALTH COOPERATIVE SOUTH CENTRAL WISCONSIN – 39167 – INST CLAIMS.”
- Once you are set up with Change Healthcare they will send your claims on directly to GHC-SCW to process.
Please note the entire setup will be completed between Change Healthcare and you directly or your clearinghouse, not with GHC-SCW.
To receive electronic EOBs/ERAs you must complete the setup form with our clearinghouse, Change Healthcare.
Steps to enroll through Change Healthcare:
- Click this link.
- Search for 39167 (GHC-SCW’s number) to get to the Change Healthcare form below and send it to Change Healthcare.
- Scroll down to find the right form. It should include “Group Health Cooperative” and “Prof ERA” or “Inst ERA” in the title.
- Once you are set up with Change Healthcare they will forward your ERA form on to EDI@ghcscw.com to complete the process on our end.
Please note the entire setup will be completed between Change Healthcare and you directly or your clearinghouse, not with GHC-SCW.
Provider Resource Manual
If you would like a printed copy of the GHC-SCW Provider Resource Manual, please contact your provider coordinator or email us at member_services@ghcscw.com