Instructions for Form F-11040 Prior Authorization / Child / Adolescent Day Treatment Attachment (Pa / Cadta) - Wisconsin

Form F-11040 Prior Authorization/Child/Adolescent Day Treatment Attachment (Pa/Cadta) - Wisconsin

This document contains official instructions for Form F-11040 , Prior Authorization/Child/Adolescent Day Treatment Attachment (Pa/Cadta) - a form released and collected by the Wisconsin Department of Health Services. An up-to-date fillable Form F-11040 is available for download through this link.

FAQ

Q: What is Form F-11040?
A: Form F-11040 is the Prior Authorization/Child/Adolescent Day Treatment Attachment form.

Q: What is the purpose of Form F-11040?
A: The purpose of Form F-11040 is to request prior authorization for Child/Adolescent Day Treatment services in Wisconsin.

Q: Who needs to fill out Form F-11040?
A: Providers who offer Child/Adolescent Day Treatment services need to fill out Form F-11040.

Q: What information is required on Form F-11040?
A: Form F-11040 requires information such as the child/adolescent's name, date of birth, diagnosis, treatment plan, and supporting documentation.

Q: How long does it take to process Form F-11040?
A: The processing time for Form F-11040 may vary, but it is typically reviewed within 10 business days.

Q: Can Form F-11040 be submitted electronically?
A: Yes, Form F-11040 can be submitted electronically through the Wisconsin Medicaid web portal.

Q: Are there any fees associated with Form F-11040?
A: No, there are no fees associated with submitting Form F-11040.

Q: Who can I contact for assistance with Form F-11040?
A: For assistance with Form F-11040, you can contact the Wisconsin Department of Health Services or your designated Managed Care Organization (MCO).

Q: Is Form F-11040 specific to Wisconsin?
A: Yes, Form F-11040 is specific to the state of Wisconsin.