WI · guidance
Wis. ForwardHealth Online Handbook, Hospice, Topic #408
Non-Network Providers
Providers who do not have a contract with the enrollee's BadgerCare Plus HMO or Medicaid SSI HMO are referred to as non-network providers. (HMO and SSI HMO network providers agree to payment amounts and billing procedures in a contract with
the HMO or SSI HMO.) Non-network providers are required to direct enrollees to HMO or SSI HMO network providers
except in the following situations:
• When a non-network provider is treating an HMO or SSI HMO enrollee for an emergency medical condition as defined in
the contract between the Wisconsin DHS (Department of Health Services) and the HMO or SSI HMO
• When the HMO or SSI HMO has authorized (in writing) an out-of-plan referral to a non-network provider
• When the service is not provided under the HMO's or SSI HMO's contract with the DHS (such as dental, chiropractic,
and pharmacy services)
Non-network providers may not serve BadgerCare Plus HMO or Medicaid SSI HMO enrollees as private-pay patients.
Provenance
- Source
- www.forwardhealth.wi.gov
- Retrieved
- 2026-10-02
- Edition
- forwardhealth-hospice-2026-10-01
- Content hash
a690febc88decc709f2f8f7662b69084828b80b4283f910ab51609dbaa6b2010
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