MedicaidPrior AuthHigh impact
Separate Prior Authorization Is Required Under the BadgerCare Plus Benchmark Plan
Wisconsin Medicaid (ForwardHealth)·WI·Prior Authorization
Effective date
Sep 1, 2008
We identified it
Jun 20, 2026
Summary
BadgerCare Plus providers must now obtain separate prior authorizations for Standard Plan and Benchmark Plan - PAs are not transferable between these two plan types when members switch enrollment. Providers must verify member enrollment before each visit and submit new PA requests when members change between these specific plans.
Action Required
Immediately: Billing team must update workflows to verify BadgerCare Plus member enrollment status before each visit using ForwardHealth Portal. When members switch between Standard Plan and Benchmark Plan, obtain new prior authorization - existing PAs do not transfer between these plans. Front desk staff must flag plan changes and alert providers to submit new PA requests. Track PA limits separately for each plan type to avoid claim denials.