MedicaidAdministrativeMedium impact
Clarifications to BadgerCare Plus and Medicaid SSI Managed Care Provider Appeal Policy
Wisconsin Medicaid (ForwardHealth)·WI·Medical Policy
Effective date
Jul 1, 2017
We identified it
Jun 20, 2026
Summary
This policy clarifies the appeal process for BadgerCare Plus and Medicaid SSI managed care providers in Wisconsin. It establishes a two-step appeal process: first appeal to the HMO within their timeline, then to ForwardHealth within 60 days if unsatisfied, and introduces revised appeal forms F-12022 and completion instructions F-12022A.
Action Required
Immediately: Billing team should download the new Managed Care Program Provider Appeal form F-12022 (07/2017) and completion instructions F-12022A from ForwardHealth Portal. Update appeal procedures to ensure all required documentation is included: original claim, HMO denial remittance, written appeal to HMO, HMO response, relevant medical records, and supporting contract language. File HMO appeals first within HMO timelines, then ForwardHealth appeals within 60 days if needed. Notify ForwardHealth at 608-224-6318 if HMO subsequently pays after appeal submission.