Wis. ForwardHealth Online Handbook, Hospice, Topic #16177

Care4Kids is a health care program for children and youth in out-of-home care in Wisconsin. The Care4Kids program will offer

comprehensive, coordinated services that are intended to improve the quality and timeliness of and access to health services for

these children.

The Care4Kids program will serve children in out-of-home care placements (other than residential care centers) in Kenosha,

Milwaukee, Ozaukee, Racine, Washington, and Waukesha counties. Member participation will be voluntary, and enrollment will

be allowed to continue for up to 12 months after the child leaves the out-of-home care system, as long as the child remains

Medicaid-eligible and resides within one of the six counties.

Care4Kids is required to provide at least the same benefits as those provided under fee-for-service arrangements.

Program Administration

Children's Hospital of Wisconsin is currently the only integrated health system certified by ForwardHealth to administer the

Care4Kids program. Children's Hospital of Wisconsin will be responsible for providing or arranging for the provision of all

services covered under Medicaid, with a small number of exceptions. The services not included in the Care4Kids program will be

reimbursed as fee-for-service benefits. Children's Hospital of Wisconsin's integrated network of health care providers, which

includes specialty and primary care physicians and clinics within the Children's Hospital System as well as providers who are

participating in CCHP (Children's Community Health Plan), is intended to provide coordinated care and services to meet the

individualized needs of each of the children enrolled across multiple disciplines, including physical, behavioral health, and dental

care.

Care4Kids will be responsible for providing or arranging for the provision of all medically necessary services covered by

Wisconsin Medicaid to enrollees. Providers are required to be part of the CCHP network to get reimbursed by Care4Kids.

Providers interested in being a part of the network should contact CCHP. Out-of-network providers are required to call

Care4Kids prior to providing services to a Care4Kids enrollee. In situations where emergency medical services are needed, out-of-network providers are required to contact Care4Kids within 24 hours of providing services.

Member Enrollment Verification

Providers should verify a member's enrollment before providing services to determine if the member is enrolled in Care4Kids.

Members enrolled in Care4Kids will present a ForwardHealth member identification card.

Providers verifying enrollment on the ForwardHealth Portal will see Care4Kids under the MC Program heading in the Managed

Care Enrollment panel.

For 271 response transactions, Care4Kids enrollment will be identified in the EB segment of the 2110C loop. Identified by MC in

the EB01, HM in the EB04, and Care4Kids in the EB05. The MC provider contact information will be reported in the NM1

(name info), N3 (address info), and PER (telephone numbers) segments within the 2120C loop.

The WiCall AVR (automated voice response) system will identify Care4Kids as the state-contracted managed care program in

which the member is enrolled.

Contact Information

Providers can contact CCHP at 800-482-8010 for the following:

• To become part of the CCHP network

• For coverage policy and procedure information, including PA (prior authorization) and claim submission guidelines, if they

are already a Care4Kids network provider