MedicaidCoverageHigh impact
Billing Members for Covered Services, Noncovered Services, and Cost Sharing Under BadgerCare Plus
Wisconsin Medicaid (ForwardHealth)·WI·Billing
Effective date
Feb 1, 2008
We identified it
Jun 20, 2026
Summary
BadgerCare Plus launches February 1, 2008, merging Wisconsin Medicaid programs into Standard and Benchmark plans. The Benchmark Plan has visit/dollar limits for services like therapy, inpatient stays, and DME, requiring providers to collect payment from members for noncovered services after limits are exceeded.
Action Required
By February 1, 2008: Billing team must implement BadgerCare Plus billing procedures - track Benchmark Plan service limitations (therapy visits, inpatient stays, home health, nursing home, routine eye exams, DME dollar limits). Update billing system to identify Standard vs Benchmark Plan members. Train staff to obtain written payment agreements from Benchmark Plan members before providing noncovered services. Update encounter forms to track enrollment year service limits. Failure to track limits will result in unpaid claims when members exceed coverage.