MedicaidAdministrativeHigh impact
Reminder: Reimbursement for Laboratory Procedures Requires Valid CLIA Certification
Wisconsin Medicaid (ForwardHealth)·WI · Pathology·Medical Policy
Effective date
Oct 1, 2011
We identified it
Jun 20, 2026
Summary
ForwardHealth (Wisconsin Medicaid/BadgerCare Plus) now requires valid CLIA certification on file to receive reimbursement for laboratory procedures. Claims for CLIA-monitored lab procedures will be denied if providers lack proper certification or have the wrong certification level for the date of service.
Action Required
Immediately: All providers performing laboratory procedures must verify their CLIA certification is current and on file with ForwardHealth by calling Provider Services at (800) 947-9627. If certification is missing or outdated, send a copy of the valid CLIA certificate to ForwardHealth Provider Maintenance at 6406 Bridge Rd, Madison WI 53784-0006. Claims will be denied with EOB code 0794 or reason code A1 with remark M51 without proper certification.