Why are Medicare and Medicaid shown separately instead of combined?

They come from two different CMS data sources with no shared claim identifier, so they can't be reconciled into one number without double-counting or guessing. Every table and chart on this page keeps them fully separate.

Why is there no private/commercial revenue figure?

Private and commercial payer data comes from Transparency in Coverage files, which only publish negotiated rates — not claims or utilization volume. Without a volume figure, no revenue number can be computed for any provider from that data.

What does "Rank" mean in the Competitive Analysis & Benchmarks tables?

For a given CPT/HCPCS code, it's this provider's position by claims volume among all providers billing that same code at that geography level (State, National, or Wisconsin for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to Wisconsin only?

Medicaid is administered per-state with no single national fee schedule, so a state or national comparison the way Medicare has one isn't available. Wisconsin (this provider's own state) is the only grouping that's conceptually meaningful.

Why are the numbers rounded to the nearest 10?

To avoid implying more precision than the underlying data supports at a single-provider level. Ratios are kept precise since they're a relative comparison, not a volume or dollar figure.

How current is this data?

The Medicare and Medicaid tables are both single current snapshots, not refreshed on a recurring schedule yet.

Community Care Health Plan, Inc (NPI 1154479822)

Field	Value
Entity Type	Organization
Organization	Community Care Health Plan, Inc
Address	205 Bishops Way
City	Brookfield
State	WI
ZIP	53005
Taxonomy	Health Maintenance Organization
NPI Enumerated	January 8, 2007

Payer Source	Total Paid
Medicaid	$63.1M
Medicare	$0

Key Findings

COMMUNITY CARE HEALTH PLAN, INC shows no Medicare billing on file and is effectively a single-payer Medicaid operation, with Total Medicaid revenue of $63.1M driving its public-program business footprint. The absence of Medicare revenue means analyses and competitive comparisons should focus on Medicaid claims and codes rather than dual-payer strategies or Medicare-targeted service lines.

Revenue concentration is extreme: the top 3 Medicaid codes account for 94.0% of this provider's total Medicaid revenue, indicating that a very small set of services (particularly T1017) dominates its financial profile. This concentration suggests limited service-line diversification within publicly billed care and a high operational dependence on the activities captured by those leading codes.

T1017 (Targeted case management, each 15 minutes) is the primary revenue driver with $57M in revenue (90.3% of the providers Medicaid total) and 838K claims, and the provider ranks #1 of 87 in-state (100th percentile). This makes COMMUNITY CARE HEALTH PLAN, INC an extreme outlier in Wisconsin for targeted case management, implying the organization functions largely as a case-management-focused entity rather than a typical medical/clinical provider.

Secondary Medicaid service lines are far smaller in scale: T1016 (Case management, each 15 minutes) produced $1.5M (2.3% of Medicaid revenue) and ranks mid-table (#96 of 224, 57th percentile), while T2004 (Non-emergency transport; commercial carrier, multi-pass) contributed $871.6K (1.4% of revenue) and ranks #1 of 4 in-state. These figures show that beyond targeted case management the provider maintains modest ancillary payments for care coordination and transport services, consistent with a social-support and care-navigation operating model.

Numerous DME and incontinence supply codes (T4528, T4527, T4541, T4526, T4535, T4523 and others) appear across the top-25 Medicaid list and together represent several smaller revenue streams, each typically ranking near the top among a small set of in-state suppliers (many 50thto 100th percentile placements). This mix indicates routine provision or billing for durable medical supplies and personal-care products to support enrolled members, aligning with long-term care or community support functions associated with case-management programs.

Competitive standing is uneven: the provider is a statewide market leader for T1017 (100th percentile and described as an extreme outlier), and it also ranks first for several transport and supply codes, but it is only a typical or modest participant for many other Medicaid codes where its percentile ranks fall in the mid-range. Analysts should treat COMMUNITY CARE HEALTH PLAN, INC as a dominant specialist for targeted case management and a leading, though narrower, participant in certain transportation and supply categories rather than a full-service clinical competitor.

The enrollment tenure is long enough to indicate an established presence: the NPI was enumerated on 2007-01-08 (~19 years ago). That longevity combined with the concentrated billing pattern suggests an enduring organizational role in Medicaid case-management and related support services in Wisconsin rather than a new entrant or transient billing profile.

Several codes are flagged as notably above typical or high relative to peers: T1017 is an extreme outlier and T1001 (Nursing assessment / evaluation) ranks #1 of 7 providers (100th percentile, described as notably above typical state volume). These statistical labels point to focused capability in case management and nursing assessment services that exceed typical in-state volumes, reinforcing the providers specialization in coordinated, community-based care models.

Medicaid: Complete Services Breakdown

Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.

31 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T1017	Targeted case management, each 15 minutes	837,960	$70	$57M
T1016	Case management, each 15 minutes	9,890	$150	$1.5M
T2004	Non-emergency transport; commercial carrier, multi-pass	2,560	$340	$871.6K
T4528	Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each	8,200	$110	$860.8K
T4527	Adult sized disposable incontinence product, protective underwear/pull-on, large size, each	7,740	$70	$572.7K
A0110	Non-emergency transportation and bus, intra or inter state carrier	4,760	$90	$447.6K
T4541	Incontinence product, disposable underpad, large, each	7,220	$60	$426.1K
T4526	Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each	5,680	$70	$375.1K
T4535	Disposable liner/shield/guard/pad/undergarment, for incontinence, each	6,100	$60	$353.9K
T4523	Adult sized disposable incontinence product, brief/diaper, large, each	2,350	$70	$173.7K

Showing 1–10 of 31

Medicaid: Competitive Analysis & Benchmarks

How this provider's Medicaid billing volume and revenue compare to other Wisconsin providers billing the same CPT/HCPCS codes.

Claims Volume vs. Wisconsin Distribution

Community Care Health Plan, Inc — 6 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Wisconsin

Full comparison — all codes billed, vs. Wisconsin median

31 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T1017	Targeted case management, each 15 minutes	1	90	3,130	$100	$2M
T1016	Case management, each 15 minutes	96	220	7,110	$70	$1.7M
99600	Use 99600 to report a home visit service or procedure that does not have a specific code.	34	30	2,580	$90	$784K
T4528	Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each	2	10	3,880	$80	$382.7K
T4527	Adult sized disposable incontinence product, protective underwear/pull-on, large size, each	3	10	7,740	$60	$371.8K
T2004	Non-emergency transport; commercial carrier, multi-pass	1	10	1,540	$190	$269.9K
T4526	Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each	3	10	5,680	$60	$257K
T4535	Disposable liner/shield/guard/pad/undergarment, for incontinence, each	2	10	4,240	$40	$251.7K
A0110	Non-emergency transportation and bus, intra or inter state carrier	1	10	3,740	$80	$240.5K
A0100	Non-emergency transportation; taxi	6	10	5,280	$30	$234K

Showing 1–10 of 31

Nearby Providers

Other providers in the same ZIP code as Community Care Health Plan, Inc, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Linda Klotz	WI	Behavior Analyst	$0	$2.9M
Alec H. Jaret, Dmd, PC	WI	Dentist	$0	$2.4M
Heather Martyn	WI	Behavior Analyst	$0	$2.4M
Samantha Gates	WI	Behavior Analyst	$0	$2.2M
Holly Bruski	WI	Behavior Analyst	$0	$1.9M
Brittany Naida	WI	Behavior Analyst	$0	$1.7M
Thomas Kelley	WI	Periodontics	$0	$1.7M
Hospice Preferred Choice, Inc	WI	Community Based Hospice Care Agency	$0	$1.5M
Family Options Counseling, LLC	WI	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$1.3M
Dermatopathology Of Wisconsin Sc	WI	Clinical Medical Laboratory	$1M	$304.1K

Community Care Health Plan, Inc — Billing Profile & Reimbursement Data

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Community Care Health Plan, Inc — Billing Profile & Reimbursement Data

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Key Findings

Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Nearby Providers

Frequently Asked Questions

References