WI · guidance
Wis. ForwardHealth Online Handbook, Hospice, Topic #401
BadgerCare Plus HMO Program
An HMO is a system of health care providers that provides a comprehensive range of medical services to a group of enrollees.
HMOs receive a fixed, prepaid amount per enrollee from ForwardHealth (called a capitation payment) to provide medically
necessary services.
BadgerCare Plus HMOs are responsible for providing or arranging all contracted covered medically necessary services to
enrollees. BadgerCare Plus members enrolled in state-contracted HMOs are entitled to at least the same benefits as fee-for-service members; however, HMOs may establish their own requirements regarding PA (prior authorization), claims submission,
adjudication procedures, etc., which may differ from fee-for-service policies and procedures. BadgerCare Plus HMO network
providers should contact their HMO for more information about its policies and procedures.
Provenance
- Source
- www.forwardhealth.wi.gov
- Retrieved
- 2026-10-02
- Edition
- forwardhealth-hospice-2026-10-01
- Content hash
a3b2406ab086a59ca224f23735e2237be06be43ed39584dba8f69a0ab5a61813
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