Community Care, Inc. - Coverage Determination

Out-of-Network Coverage

Coverage Determinations

Formulary Exceptions

Appeals

Grievances

Pharmacy

Contract Termination

Coverage Determinations

You can request a coverage determination anytime you feel you need a service or benefit covered by Community Care. Please call your Partnership Team to request a coverage determination. You can also submit a written request to:

Community Care
Attn: Coverage Determination Request
1555 S. Layton Blvd.
Milwaukee, WI 53215

Toll Free: (866) 992-6600
TTY: (866) 288-9909

If your coverage determination involves your prescription drug coverage, Community Care will treat it as a Formulary Exception request.

Frequently Requested Links

To find the best available evidence (BAE) to see if you qualify for the Low Income Subsidy (LIS) please visit this website.
Centers for Medicare & Medicaid Services

Community Care Formulary
(updated: 8/23/10)

Summary of Benefits
(updated: 09/15/08)

Evidence of Coverage
(updated: 10/10/08)

Low Income Subsidy Rider
(updated: 10/10/08)

Annual Notice of Change
(updated: 09/15/08)

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