MedicaidPrior AuthMedium impact
Explanation of Prior Authorization Requirements for HealthCheck "Other Services"
Wisconsin Medicaid (ForwardHealth)·WI · Pediatrics·Prior Authorization
Effective date
Feb 1, 2019
We identified it
Jun 20, 2026
Summary
Wisconsin Medicaid clarified prior authorization submission requirements for HealthCheck 'Other Services' for members under 21. For services not routinely covered, providers must check the HealthCheck box and use modifier EP, while coverage limit exceptions are processed automatically without special identification.
Action Required
For Wisconsin Medicaid members under 21: When requesting PA for services not routinely covered, billing team must check the HealthCheck 'Other Services' box in Element 1 of PA forms and add modifier EP in Element 20. For coverage limit exceptions, do NOT check the HealthCheck box as requests are processed automatically. Update PA submission workflows accordingly.