MedicaidAdministrativeHigh impact
Wisconsin Medicaid restricts billing recipients, What's new on the Medicaid Web site, Reminder: Electronic claims submission schedule for November 2001, Wisconsin Medicaid and BadgerCare HMO Ombudsmen
Wisconsin Medicaid (ForwardHealth)·WI·Billing
Effective date
Oct 1, 2001
We identified it
Jun 20, 2026
Summary
Wisconsin Medicaid providers are prohibited from billing recipients for Medicaid-covered services except for required copayments, even if claims are denied due to provider non-compliance or lack of prior authorization. Providers must attempt to collect fee-for-service copayments but cannot deny services for non-payment.
Action Required
Immediately: Billing team must stop all attempts to balance bill Wisconsin Medicaid recipients for covered services, even when claims are denied for provider errors or missing prior authorization. Update billing system to prevent recipient billing for covered services. Train staff that only copayments can be collected from fee-for-service recipients. Violation can result in fines up to $25,000 and program termination.