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BadgerCare Plus Forms

Below is a list of all BadgerCare Plus forms. 

When you are searching for a document, enter the number or a portion of the title in the search box below.

Assigned Number Title Division Language Release Date File Type Available to Order
F-11040A Prior Authorization / Child / Adolescent Day Treatment Attachment (PA/CADTA) Instructions DMS English 12/2019 PDF No
F-11029 Prior Authorization / Chiropractic Attachment (PA/CA) DMS English 07/2012 PDF No
F-11029 Prior Authorization / Chiropractic Attachment (PA/CA) DMS English 07/2012 Word No
F-11029A Prior Authorization / Chiropractic Attachment (PA/CA) Completion Instructions DMS English 10/2008 PDF No
F-11010 Prior Authorization / Dental Attachment 1 (PA/DA1) Check Box Format DMS English 01/2019 Word No
F-11010 Prior Authorization / Dental Attachment 1 (PA/DA1) Check Box Format DMS English 01/2019 PDF No
F-11014 Prior Authorization / Dental Attachment 2 (PA/DA2) Oral Surgery, Orthodontic, and Fixed Prosthetic Services DMS English 02/2020 Word No
F-11014 Prior Authorization / Dental Attachment 2 (PA/DA2) Oral Surgery, Orthodontic, and Fixed Prosthetic Services DMS English 02/2020 PDF No
F-00239 Prior Authorization / Drug Attachment for Blood Glucose Meters and Test Strips DMS English 12/2013 PDF No
F-00239 Prior Authorization / Drug Attachment for Blood Glucose Meters and Test Strips DMS English 12/2013 Word No
F-00239A Prior Authorization / Drug Attachment for Blood Glucose Meters and Test Strips Completion Instructions DMS English 07/2015 PDF No
F-11030 Prior Authorization / Durable Medical Equipment Attachment (PA/DMEA) DMS English 02/2024 Word No
F-11030 Prior Authorization / Durable Medical Equipment Attachment (PA/DMEA) DMS English 02/2024 PDF No
F-11030A Prior Authorization / Durable Medical Equipment Attachment (PA/DMEA) Instructions DMS English 02/2024 PDF No
F-11088 Prior Authorization / Health and Behavior Intervention Attachment (PA/HBA) DMS English 07/2012 PDF No
F-11088 Prior Authorization / Health and Behavior Intervention Attachment (PA/HBA) DMS English 07/2012 Word No
F-11088A Prior Authorization / Health and Behavior Intervention Attachment (PA/HBA): Completion Instructions DMS English 07/2012 PDF No
F-11044 Prior Authorization / Home Health Therapy / Attachment (PA/HHTA) DMS English 07/2012 Word No
F-11044 Prior Authorization / Home Health Therapy / Attachment (PA/HHTA) DMS English 07/2012 PDF No
F-11044A Prior Authorization / Home Health Therapy / Attachment (PA/HHTA): Completion Instructions DMS English 07/2012 PDF No
F-11036 Prior Authorization / In-Home Treatment Attachment (PA / ITA) DMS English 12/2019 Word No
F-11036 Prior Authorization / In-Home Treatment Attachment (PA / ITA) DMS English 12/2019 PDF No
F-11036A Prior Authorization / In-Home Treatment Attachment (PA / ITA): Completion Instructions DMS English 12/2019 PDF No
F-11033 Prior Authorization / Mental Health and/or Substance Abuse Evaluation Attachment (PA / EA) DMS English 07/2012 Word No
F-11033 Prior Authorization / Mental Health and/or Substance Abuse Evaluation Attachment (PA / EA) DMS English 07/2012 PDF No
F-11033A Prior Authorization / Mental Health and/or Substance Abuse Evaluation Attachment (PA / EA) Completion Instructions DMS English 10/2008 PDF No
F-11066 Prior Authorization / Oxygen Attachment (PA/OA) DMS English 07/2012 PDF No
F-11066 Prior Authorization / Oxygen Attachment (PA/OA) DMS English 07/2012 Word No
F-11066A Prior Authorization / Oxygen Attachment (PA/OA): Completion Instructions DMS English 08/2015 PDF No
F-11016A Prior Authorization / Physician Attachment (PA/PA) Completion Instructions DMS English 07/2012 PDF No
F-11019 Prior Authorization / Physician Otological Report (PA/POR) DMS English 07/2012 PDF No
F-11019 Prior Authorization / Physician Otological Report (PA/POR) DMS English 07/2012 Word No
F-11019A Prior Authorization / Physician Otological Report (PA/POR) Completion Instructions DMS English 07/2012 PDF No
F-11305 Prior Authorization / Preferred Drug List (PA/PDL) for Cytokine and Cell Adhesion Molecule (CAM) Antagonist Drugs for Crohn's Disease DMS English 01/2016 PDF No
F-11305A Prior Authorization / Preferred Drug List (PA/PDL) for Cytokine and Cell Adhesion Molecule (CAM) Antagonist Drugs for Crohn's Disease: Completion Instructions DMS English 01/2016 PDF No
F-11307 Prior Authorization / Preferred Drug List (PA/PDL) for Cytokine and Cell Adhesion Molecule (CAM) Antagonist Drugs for Plaque Psoriatic Arthritis DMS English 12/2012 PDF No
F-11307A Prior Authorization / Preferred Drug List (PA/PDL) for Cytokine and Cell Adhesion Molecule (CAM) Antagonist Drugs for Plaque Psoriatic Arthritis: Completion Instructions DMS English 07/2015 PDF No
F-11308 Prior Authorization / Preferred Drug List (PA/PDL) for Cytokine and Cell Adhesion Molecule (CAM) Antagonist Drugs for Plaque Rheumatoid Arthritis DMS English 12/2012 PDF No
F-11308A Prior Authorization / Preferred Drug List (PA/PDL) for Cytokine and Cell Adhesion Molecule (CAM) Antagonist Drugs for Plaque Rheumatoid Arthritis: Completion Instructions DMS English 07/2015 PDF No
F-00694A Prior Authorization / Preferred Drug List (PA/PDL) for Cytokine and Cell Adhesion Molecule (CAM) Antagonist Drugs for Ulcerative Colitis Completion Instructions DMS English 07/2015 PDF No
F-00281 Prior Authorization / Preferred Drug List (PA/PDL) for Fentanyl Mucosal Agents DMS English 07/2013 PDF No
F-00281 Prior Authorization / Preferred Drug List (PA/PDL) for Fentanyl Mucosal Agents DMS English 07/2013 Word No
F-00281A Prior Authorization / Preferred Drug List (PA/PDL) for Fentanyl Mucosal Agents Completion Instructions DMS English 07/2015 PDF No
F-00622 Prior Authorization / Preferred Drug List (PA/PDL) for Migraine Agents, Injectable DMS English 06/2012 PDF No
F-00280 Prior Authorization / Preferred Drug List (PA/PDL) for Migraine Agents, Other DMS English 07/2013 PDF No
F-11097 Prior Authorization / Preferred Drug List (PA/PDL) for Stimulants and Related Agents DMS English 09/2019 Word No
F-11097 Prior Authorization / Preferred Drug List (PA/PDL) for Stimulants and Related Agents DMS English 09/2019 PDF No
F-11097A Prior Authorization / Preferred Drug List (PA/PDL) for Stimulants and Related Agents: Completion Instructions DMS English 07/2015 PDF No
F-00080 Prior Authorization / Preferred Drug List (PA/PDL) for Symlin DMS English 10/2011 PDF No
F-00080A Prior Authorization / Preferred Drug List (PA/PDL) for Symlin Completion Instructions DMS English 07/2015 PDF No

Glossary

 
Last revised January 24, 2023