MedicaidAdministrativeMedium impact
Procedures to follow when a recipient appeal is successful
Wisconsin Medicaid (ForwardHealth)·WI·Medical Policy
Effective date
Aug 1, 2001
We identified it
Jun 20, 2026
Summary
This Wisconsin Medicaid policy outlines procedures for providers when recipient appeals for prior authorization denials or eligibility determinations are successful. Providers must resubmit claims with appeal decisions attached to a specific address and follow new PA request procedures when appeals are won.
Action Required
Wisconsin providers: When recipients win appeals for denied prior authorizations or eligibility determinations, obtain copy of appeal decision from recipient and resubmit claims with decision attached to Wisconsin Medicaid Specialized Research, Suite 50, 6406 Bridge Road, Madison, WI 53784-0050. For PA reversals, may need to submit new PA request form with original attachments and appeal decision copy. Ensure all resubmissions occur within 365-day deadline from original service date.