All Insurance Policy Changes (Page 429)

Continuing from page 428. Showing older policy changes tracked across all payers. Use the filters in the related-hubs section below to narrow by provider, state, or specialty.

High impact
The HIPAA standards, The HIPAA Electronic Transactions standard, HIPAA-compliant code sets, Implementation guides, Terms and definitions, HIPAA-related Web sites
Wisconsin Medicaid (ForwardHealth)·Identified Jun 20, 2026
HIPAA Administrative Simplification standards establish national requirements for electronic healthcare transactions, including standardized formats for claims submission, eligibility verification, and remittance advice. All covered entities must adopt specific ASC X12N and NCPDP format standards for electronic transactions and use only approved medical code sets (CPT-4, HCPCS, ICD-9-CM, CDT, NDC).
High impact
Wisconsin Medicaid restricts billing recipients, What's new on the Medicaid Web site, Reminder: Electronic claims submission schedule for November 2001, Wisconsin Medicaid and BadgerCare HMO Ombudsmen
Wisconsin Medicaid (ForwardHealth)·Effective Oct 1, 2001
Wisconsin Medicaid providers are prohibited from billing recipients for Medicaid-covered services except for required copayments, even if claims are denied due to provider non-compliance or lack of prior authorization. Providers must attempt to collect fee-for-service copayments but cannot deny services for non-payment.
Medium impact
How "medically necessary" is applied when evaluating prior authorization requests, What's new on the Medicaid Web site
Wisconsin Medicaid (ForwardHealth)·Effective Nov 1, 2001
Wisconsin Medicaid (ForwardHealth) has updated guidance on how 'medically necessary' criteria are applied when evaluating prior authorization requests. This policy clarifies the standards and evaluation process for determining medical necessity in prior auth decisions.
Medium impact
Where to submit paper claims for state health care benefits programs, Veterans' benefits available through the Wisconsin Department of Veterans Affairs, Electronic claims submission schedule for 2002, What's new on the Medicaid Web site
Wisconsin Medicaid (ForwardHealth)·Effective Dec 1, 2001
Wisconsin updated mailing addresses for paper claims submission across multiple state health programs including Medicaid, BadgerCare, HIRSP, and chronic disease programs. The policy also provides veteran benefits information and electronic claims submission schedules for 2002.
Medium impact
Summary of Wisconsin Medicaid handbooks published in 2001, New fax cover sheet, HCF 1176 available for prior authorization requests, Medicaid Basic Training offered, What's new on the Medicaid Web site
Wisconsin Medicaid (ForwardHealth)·Effective Jan 1, 2002
Wisconsin Medicaid published new handbooks in 2001 and introduced a new fax cover sheet (HCF 1176) for prior authorization requests. Providers are strongly urged to use the new cover sheet when faxing PA requests to help verify complete transmission and expedite processing.
Low impact
Wisconsin Medicaid provider certification packets available on Medicaid Web site, What's new on the Medicaid Web site, Accessing Wisconsin Medicaid eligibility information
Wisconsin Medicaid (ForwardHealth)·Effective Feb 1, 2002
Wisconsin Medicaid now provides provider certification packets online as downloadable PDF files on their website, allowing new providers to obtain certification materials without calling Provider Services. The policy also clarifies certification effective date rules based on submission timing.
Low impact
All-Provider Handbook available on CD-Rom, All Wisconsin counties have a county veterans service office, What's new on the Medicaid and BadgerCare Web sites, New Medicare crossover claim agreements established
Wisconsin Medicaid (ForwardHealth)·Effective Mar 1, 2002
Wisconsin Medicaid now distributes the All-Provider Handbook on CD-ROM with enhanced search capabilities and has established new Medicare crossover claim agreements with four additional intermediaries/carriers for automatic claim processing.
Medium impact
Release of billing or medical information by providers, Medicaid Basic Training offered in May and June, What's new on the Medicaid and BadgerCare Web sites
Wisconsin Medicaid (ForwardHealth)·Effective Apr 1, 2002
Wisconsin Medicaid has updated procedures for how providers must handle requests for billing or medical information relating to Medicaid recipients. Providers must now notify Wisconsin Medicaid when releasing billing information (with specific exceptions) and follow different protocols based on who is requesting the information.
Medium impact
Verifying Medicaid eligibility of foster care children, Deactivated and defective Medicaid Forward cards, What�s new on the Medicaid and BadgerCare Web sites
Wisconsin Medicaid (ForwardHealth)·Effective May 1, 2002
Wisconsin Medicaid updated procedures for verifying eligibility of foster care children and handling deactivated/defective Medicaid Forward cards. Foster care children should have Medicaid Forward cards or green temporary cards, and providers must use specific verification methods when cards are inactive or defective.
Low impact
Announcing the new Wisconsin Medicaid and BadgerCare Update Summary, Introducing Wisconsin Well Woman Medicaid, What's new on the Medicaid and BadgerCare Web sites
Wisconsin Medicaid (ForwardHealth)·Effective Jul 1, 2002
Wisconsin is transitioning from full-text Medicaid/BadgerCare updates to a single-page summary format starting July 2002, with full articles available via internet, email, or phone. Additionally, a new Wisconsin Well Woman Medicaid program provides full Medicaid benefits to women ages 35-64 diagnosed with breast/cervical cancer or pre-cancerous cervical conditions through the Wisconsin Well Woman Program.
Medium impact
Changes in Wisconsin Medicaid recipient identification numbers and names
Wisconsin Medicaid (ForwardHealth)·Identified Jun 20, 2026
Wisconsin Medicaid clarifies that providers should proceed with services when the Eligibility Verification System (EVS) shows a patient is eligible, even if the patient's Forward card shows a different 10-digit ID number or name. Claims can be submitted using either the old or new ID numbers/names due to cross-referencing in the system.
High impact
HIPAA affects all providers — not just those who submit electronic claims
Wisconsin Medicaid (ForwardHealth)·Identified Jun 20, 2026
HIPAA compliance affects all Medicaid providers, not just those submitting electronic claims. Wisconsin Medicaid will eliminate local codes and adopt standardized medical code sets (CPT-4, HCPCS, ICD-9-CM, etc.) and non-medical code sets, requiring changes to paper billing processes and forms.
Low impact
New Wisconsin Medicaid Provider Materials Order form
Wisconsin Medicaid (ForwardHealth)·Effective Jul 1, 2002
Wisconsin Medicaid has introduced a new Provider Materials Order Form for ordering provider handbooks and binders. Providers can obtain the form online, via email, or by phone, and must use a fresh copy for each order as pricing and availability may change without notice.
Medium impact
SeniorCare program begins in September
Wisconsin Medicaid (ForwardHealth)·Effective Sep 1, 2002
Wisconsin's new SeniorCare prescription drug program launches September 1, 2002, providing prescription coverage for Wisconsin residents 65+ with income-based benefits. Providers must be Medicaid certified and bill commercial insurance before billing SeniorCare.
Low impact
Wisconsin Medicaid reorganizes Web site
Wisconsin Medicaid (ForwardHealth)·Effective Aug 1, 2002
Wisconsin Medicaid has reorganized its website to improve provider access to billing information, forms, and resources. The new site structure includes dedicated provider pages with direct links to handbooks, forms, fee schedules, and prior authorization tools.
Low impact
Medicaid Basic Training offered in October
Wisconsin Medicaid (ForwardHealth)·Effective Oct 1, 2002
Wisconsin Medicaid is offering free basic training sessions for new providers and billing staff in October 2002 at three northern Wisconsin locations. The training covers fundamental Medicaid procedures including eligibility, claims submission, and HIPAA requirements.
Medium impact
Wisconsin SeniorCare participants eligible only for prescription drug benefits
Wisconsin Medicaid (ForwardHealth)·Effective Aug 1, 2002
Wisconsin SeniorCare is a new prescription drug assistance program for Wisconsin residents 65+ that only covers prescription drugs and over-the-counter insulin, not other Medicaid or BadgerCare services. Only Medicaid-certified drug dispensing providers can submit SeniorCare claims, and providers must verify eligibility using new EVS status responses.
Low impact
Two All-Provider Handbook forms revised
Wisconsin Medicaid (ForwardHealth)·Effective Sep 1, 2002
Wisconsin Medicaid has revised two provider forms effective immediately: the Provider Change of Address or Status form (HCF 1181) and the Declaration of Supervision for Nonbilling Providers form (HCF 1182). The forms have been simplified and certain mental health providers are no longer required to submit supervision declarations.
Medium impact
Definition of outpatient hospital services
Wisconsin Medicaid (ForwardHealth)·Effective Sep 1, 2002
This Wisconsin Medicaid policy clarifies that outpatient hospital rate-per-visit reimbursement is only available for services provided in facilities specifically approved by the Bureau of Quality Assurance (BQA) as hospitals. Freestanding facilities, even if affiliated with or located on the same property as a hospital, must bill under their own Medicaid provider numbers using appropriate claim forms for their service type.
Low impact
Revised form for indicating discrepancies in recipients' other health care coverage information
Wisconsin Medicaid (ForwardHealth)·Effective Oct 1, 2002
Wisconsin Medicaid has revised the Other Coverage Discrepancy Report form (HCF 1159) to make it clearer and easier to complete. Providers should discontinue using old versions and begin using the new form dated 10/02 to report discrepancies in recipients' other health care coverage information.
Low impact
Wisconsin Medicaid provides directory of used medical equipment donation sites
Wisconsin Medicaid (ForwardHealth)·Effective Jan 1, 2003
Wisconsin Medicaid has created a directory of donation sites where recipients can donate used medical equipment they no longer need. This is an informational resource only and does not change billing procedures or coverage policies.
Medium impact
Wisconsin Medicaid will revise claim and prior authorization instructions as a result of HIPAA
Wisconsin Medicaid (ForwardHealth)·Identified Jun 20, 2026
Wisconsin Medicaid is revising paper claim and prior authorization form instructions to comply with HIPAA Administrative Simplification provisions. Providers should monitor future Wisconsin Medicaid Updates for specific revised instructions, sample forms, and effective dates.
Medium impact
Review of recipients eligible to be enrolled in a Wisconsin Medicaid and BadgerCare HMO
Wisconsin Medicaid (ForwardHealth)·Effective Feb 1, 2003
This policy clarifies Wisconsin Medicaid and BadgerCare HMO enrollment eligibility, specifying which recipients are eligible (AFDC/AFDC-Related, BadgerCare, Healthy Start) versus excluded (Family Planning Waiver, SeniorCare, Wisconsin Well Woman). It outlines mandatory vs. voluntary enrollment based on ZIP codes, open enrollment periods, and provides contact information for HMO programs.
Low impact
HIPAA training scheduled to begin May 2003
Wisconsin Medicaid (ForwardHealth)·Effective May 1, 2003
Wisconsin Medicaid is offering HIPAA training sessions for Medicaid-certified providers starting May 2003. Providers are encouraged to register early through the Medicaid website, with more details to be published in March 2003.
Low impact
Redesigned forms page on the Medicaid Web site
Wisconsin Medicaid (ForwardHealth)·Identified Jun 20, 2026
Wisconsin Medicaid has redesigned their provider forms webpage to improve navigation and readability. All forms are now available as fillable PDFs that can be completed electronically before printing.

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The HIPAA standards, The HIPAA Electronic Transactions standard, HIPAA-compliant code sets, Implementation guides, Terms and definitions, HIPAA-related Web sites

Wisconsin Medicaid restricts billing recipients, What's new on the Medicaid Web site, Reminder: Electronic claims submission schedule for November 2001, Wisconsin Medicaid and BadgerCare HMO Ombudsmen

How "medically necessary" is applied when evaluating prior authorization requests, What's new on the Medicaid Web site

Where to submit paper claims for state health care benefits programs, Veterans' benefits available through the Wisconsin Department of Veterans Affairs, Electronic claims submission schedule for 2002, What's new on the Medicaid Web site

Summary of Wisconsin Medicaid handbooks published in 2001, New fax cover sheet, HCF 1176 available for prior authorization requests, Medicaid Basic Training offered, What's new on the Medicaid Web site

Wisconsin Medicaid provider certification packets available on Medicaid Web site, What's new on the Medicaid Web site, Accessing Wisconsin Medicaid eligibility information

All-Provider Handbook available on CD-Rom, All Wisconsin counties have a county veterans service office, What's new on the Medicaid and BadgerCare Web sites, New Medicare crossover claim agreements established

Release of billing or medical information by providers, Medicaid Basic Training offered in May and June, What's new on the Medicaid and BadgerCare Web sites

Verifying Medicaid eligibility of foster care children, Deactivated and defective Medicaid Forward cards, What�s new on the Medicaid and BadgerCare Web sites

Announcing the new Wisconsin Medicaid and BadgerCare Update Summary, Introducing Wisconsin Well Woman Medicaid, What's new on the Medicaid and BadgerCare Web sites

Changes in Wisconsin Medicaid recipient identification numbers and names

HIPAA affects all providers — not just those who submit electronic claims

New Wisconsin Medicaid Provider Materials Order form

SeniorCare program begins in September

Wisconsin Medicaid reorganizes Web site

Medicaid Basic Training offered in October

Wisconsin SeniorCare participants eligible only for prescription drug benefits

Two All-Provider Handbook forms revised

Definition of outpatient hospital services

Revised form for indicating discrepancies in recipients' other health care coverage information

Wisconsin Medicaid provides directory of used medical equipment donation sites

Wisconsin Medicaid will revise claim and prior authorization instructions as a result of HIPAA

Review of recipients eligible to be enrolled in a Wisconsin Medicaid and BadgerCare HMO

HIPAA training scheduled to begin May 2003

Redesigned forms page on the Medicaid Web site