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Graphic of the Prenatal Care Coordination Services HandbookWisconsin Medicaid 

PDF Downloads for Prenatal Care Coordination Services Handbook

Entire Handbook - PDF (776 kb)

Prenatal Care Coordination Services Handbook Sections

Handbook Cover - PDF (91kb).

Handbook Order Form - PDF (100kb).

Important Telephone Numbers - PDF (61kb).

Preface - PDF (76kb).

Table of Contents - PDF (24kb).

General Information - PDF (94kb).

Covered Services and Related Limitations - PDF (103kb).

Billing Information - PDF (104kb).

Appendix:

  • Appendix 1: HCFA 1500 Claim Form Completion Instructions for Prenatal Care Coordination Services - PDF (94kb).
  • Appendix 2: Completed Sample HCFA 1500 Claim Form - PDF (130kb).
  • Appendix 3: Completed Sample HCFA 1500 Claim Form - Second Pregnancy - PDF (131kb).
  • Appendix 4: Medicaid-Allowable Procedure Codes and Modifiers for Prenatal Care Coordination Services - PDF (78kb).
  • Appendix 5: Medicaid-Allowable Place of Service Codes and Type of Service Code for Prenatal Care Coordination Services - PDF (56kb).
  • Appendix 6: Rounding Guidelines for Prenatal Care Coordination Services - PDF (64kb).
  • Appendix 7: Medicaid Guidelines and Performance Measurements for Prenatal Care Coordination - PDF (131kb).
  • Appendix 8: Pregnancy Questionnaire - PDF (119kb).
  • Appendix 9: Instructions for Completing the Pregnancy Questionnaire - PDF (133kb).
  • Appendix 10: Pregnancy Questionnaire Summary (Sample Format) - PDF (60kb).
  • Appendix 11: Referral Form (Sample Format) - PDF (75kb).
  • Appendix 12: Informed Consent to Release/Obtain Health Care Information Form (Sample Format) - PDF (64kb).
  • Appendix 13: Care Plan (Sample Format) - PDF (91kb).
  • Appendix 14: Prenatal Care Coordination Monthly Time Long for Ongoing Care Coordination and Monitoring (Completed Sample Format) - PDF (53kb).
  • Appendix 15: Memorandum of Understanding (Sample Format) - PDF (64kb).
  • Appendix 16: Prenatal Care Coordination Resource Guide - PDF (107kb).
  • Appendix 17: Information Regarding Transportation to Medical Appointments - PDF (78kb).
  • Appendix 18: Comprehensive Agency Outreach and Case Management Plan Requirements - PDF (59kb).
  • Appendix 19: Medicaid Maximum Fee Schedules for Prenatal Care Coordination Services - PDF (78kb).

Glossary of Common Terms - PDF (92kb).

Index (for paper-copy handbook) - PDF (92kb).

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