Community Care Authorization Provider Portal

This is a portal for Community Care providers of home and community based services, allowing those providers to view and sign all their authorizations.

Providers of essential services must sign Member Care Plans. A provider of “essential services” is defined in our contract with the State of Wisconsin as providing one or more of the following services: 1) Adult Day Care Services; 2) Day Habilitation Services; 3) Daily Living Skills Training; 4) Prevocational Services; 5) Adult residential care (adult family homes, community-based residential facilities, residential care apartment complexes); 6) Respite; 7) Skilled nursing services RN/LPN; 8) Supported employment (individual and small group employment support); and 9) Supportive home care (excluding routine chore services).

Community Care has been meeting this State contractual requirement by having Care Teams work with Providers to physically sign a copy of Member Care Plans. Now, Community Care has created a Member Care Plan Portal to make it easier for you to sign the Member Care Plan. This Portal is available now and can be accessed at https://mcpportal.communitycareinc.org.

This portal is very similar to our Authorization Provider Portal, so you will be familiar with how it works. We have also taken your logins and passwords from our Authorization Provider Portal and applied them to the Member Care Plan Portal, so you will not need any new logins or passwords.

You will likely have Member Care Plans to sign beginning August 1st. Please log in to the Member Care Plan Portal (using your Authorization Provider Portal log in and password) and sign the Member Care Plans. You will do this the same way you sign authorizations in the Authorization Provider Portal. The notification function in the Member Care Plan Portal will begin sending you notifications (to the email you entered for notifications) for any new Care Plans created beginning August 2nd. You will not receive notifications from the Portal for the Care Plans in the Portal waiting to be signed on August 1st.

You will also notice in our Authorization Provider Portal, that on the page where you sign authorizations, we have added a notice about signing Care Plans for members with authorizations with certain procedure codes. We also created a link to our Member Care Plan Portal on the authorization signature page.

As a reminder, this is a requirement per our contract with the State of Wisconsin. Community Care intends to contact providers who are out of compliance (have unsigned Care Plans) on a weekly basis. Ultimately, the ability of a provider to receive authorizations and payment will be dependent of having signed the Member Care Plan in the Portal. Community Care will give providers advance notice before this action is implemented. To avoid this, we are strongly advising providers get in the habit now of signing Member Care Plans in the Portal.

Beginning July 1, 2021, supportive home care authorizations (using procedure codes S5125, S5126, S5130 and/or T1019), Community Care, Inc. (CCI) will include details from CCI’s In-Home Assessment Tool (IHAT). This additional information will outline the individual member’s care needs, appropriate tasks and their frequencies. After provider acceptance (signature) this information along with the authorization will be available in the Signature History section of the Authorization Provider Portal.

Beginning November 1st, 2018 Community Care, Inc. will no longer require prior authorization for services where Medicare or other non-Medicaid insurance providers are the primary insurer and Family Care is responsible only for deductibles , coinsurance or cost shares. This includes most DME, therapy, mental health services, and Medicare SNF Part A stays where Family Care acts as the beneficiary’s Medicaid replacement plan.

Community Care, Inc. may still choose to send an authorization or communicate in other ways with providers of these services; however, this does not imply the service will be approved without submission to Medicare or other liable parties first unless that is explicitly stated on an authorization. Claims approved by another insurer will not require an authorization for payment of deductibles and co-insurances or cost shares, but will still be subject to other claim processing standards, and claims may be denied if the other insurance does not approve payment. Per 1902(a)(25) of the Social Security Act, Medicaid is the payer of last resort meaning that Medicaid will only pay for services after all liable insurers have met legal obligations to pay.

Providers must work directly with the member’s physician to obtain supporting documentation and prior authorization required by the member’s primary insurance. If it is not possible to obtain coverage from the primary payer, providers must provide an ABN (Advance Beneficiary Notification of Non-Coverage) or other suitable documentation that the beneficiary does not meet coverage criteria to IDTS (Interdisciplinary Team Staff) prior to the delivery of any equipment or service. Community Care will not pay primary for benefits covered by a member’s primary insurance when the denial reason is lack of sufficient paperwork or without prior authorization by IDTS. When a primary insurance denies coverage, Community Care, Inc. will not approve payment unless we have provided an authorization in advance to the provider indicating that we will pay as the primary insurer.

This new coverage policy applies only to Family Care members for benefits covered by Medicare or other primary insurance at the time of service beginning November 1st 2018. There are no changes to the coverage policy for Medicaid only Family Care members or benefits not covered by Medicare or another primary insurer. These services will continue to require prior authorization as a condition of payment.

Devices

SignAuthorization.aspx

This website is constructed using responsive design. It will support smart phones, tablets and desktops.

Browsers

This site has been tested and will support Microsoft Edge, Chrome and Firefox browsers. The site may work with other browsers, but they have not been tested and will not be supported should they not function as intended.

Registration

Self-registration of providers can be accomplished by using the registration codes supplied by Community Care. If you lost the codes or need help, contact methods are available under Support.


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