Wis. ForwardHealth Online Handbook, Hospice, Topic #243

Some covered services consist of a series of sequential treatment steps, meaning more than one office visit is required to complete

treatment.

In most cases, if a member loses enrollment midway through treatment, BadgerCare Plus and Medicaid will not reimburse

services (including prior authorized services) after enrollment has lapsed.

Members are financially responsible for any services received after their enrollment has been terminated. If the member wishes to

continue treatment, it is a decision between the provider and the member whether the service should be given and how the

services will be paid. The provider may collect payment from the member if the member accepts responsibility for payment of a

service and certain conditions are met.

To avoid misunderstandings, it is recommended that providers remind members that they are financially responsible for any

continued care after enrollment ends.

To avoid potential reimbursement problems that can arise when a member loses enrollment midway through treatment, the

provider is encouraged to verify the member's enrollment using the EVS (Enrollment Verification System) or the ForwardHealth

Portal prior to providing each service, even if an approved PA (prior authorization) request is obtained for the service.