Get the free determined based on the dates that the services are rendered

An incomplete form may delay processing and/or claims payment. Member Information iCare Medicaid DOB Plan Member Name Member ID Service Type iCare BadgerCare-Plus Phone Elective/Routine 14-day turnaround time Expedited/Urgent 72-hr. Turnaround time Definition of Urgent/Expedited when the treatment requested is required to prevent imminent serious deterioration in the member s health or threatens to jeopardize the member s ability to regain maximum function. iCare reserves the right to deny...

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