MedicaidReimbursementHigh impact
Reimbursement to Members Due to Retroactive Enrollment
Wisconsin Medicaid (ForwardHealth)·WI·Medical Policy
Effective date
Oct 27, 2007
We identified it
Jun 20, 2026
Summary
Providers must now refund members the full amount they paid for services if the member becomes retroactively enrolled in Wisconsin Medicaid or BadgerCare Plus. This applies to services provided during the retroactive enrollment period, and providers must submit claims to receive reimbursement before refunding members.
Action Required
Immediately: Billing team must establish process to identify members with retroactive Medicaid/BadgerCare Plus enrollment and refund full amounts previously paid by members for covered services. Submit claims for retroactively covered services within standard timely filing limits (365 days from DOS) or within 180 days of retroactive enrollment entry into Wisconsin's Enrollment Verification System if beyond normal filing deadline. Front desk staff must track member payments to facilitate refunds when retroactive enrollment occurs.