MedicaidAdministrativeMedium impact
Medicaid as payer of last resort
Wisconsin Medicaid (ForwardHealth)·WI·Medical Policy
Effective date
Jan 1, 2004
We identified it
Jun 20, 2026
Summary
Wisconsin Medicaid reiterates its policy as payer of last resort, requiring providers to bill other health insurance sources (commercial insurance and Medicare) before submitting claims to Medicaid or state-contracted MCOs. Recipients with commercial HMO coverage must receive services from HMO-affiliated providers except for emergencies.
Action Required
Immediately: Billing team must verify all Medicaid recipients' other health insurance coverage using Wisconsin's Eligibility Verification System (EVS) under 'Third Party Liability' before submitting claims. Always bill commercial insurance and Medicare first, then submit to Medicaid as secondary payer. For recipients with commercial HMO coverage, refer them to HMO-affiliated providers except for emergency services.