MedicaidPrior AuthMedium impact
Clarifications to HealthCheck Services
Wisconsin Medicaid (ForwardHealth)·WI · Pediatrics, Family Medicine, General Practice·Medical Policy
Effective date
Feb 1, 2019
We identified it
Jun 20, 2026
Summary
Wisconsin Medicaid clarified HealthCheck (EPSDT) services for members under 21, including comprehensive screens, interperiodic screens, and 'Other Services.' Most HealthCheck 'Other Services' require prior authorization, and providers must write orders/prescriptions for recommended services following screens.
Action Required
For Wisconsin Medicaid patients under 21: Ensure providers write orders/prescriptions for all recommended services following HealthCheck screens. Billing team must obtain prior authorization for most HealthCheck 'Other Services' before providing care. Update workflows to identify when comprehensive or interperiodic screens may lead to additional covered services under HealthCheck 'Other Services.'