WI · guidance
Wis. ForwardHealth Online Handbook, Hospice, Topic #389
Provider Appeals
When a BadgerCare Plus/Medicaid SSI HMO or Children's Specialty Managed Care PIHP (Prepaid Inpatient Health Plan)
denies a provider's claim, the HMO/PIHP is required to send the provider a notice informing them of the right to file an appeal.
An HMO/PIHP network or non-network provider may file an appeal to the HMO/PIHP when:
• A claim submitted to the HMO/PIHP is denied payment.
• The full amount of a submitted claim is not paid.
Providers are required to file an appeal with the HMO/PIHP before filing an appeal with ForwardHealth.
Provenance
- Source
- www.forwardhealth.wi.gov
- Retrieved
- 2026-10-02
- Edition
- forwardhealth-hospice-2026-10-01
- Content hash
64b04ab5cf38e7c6db990769136959843b881d9a2fa0df9549dd771927337f6a
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