Wis. ForwardHealth Online Handbook, Hospice, Topic #517

For most services, providers are required to indicate their usual and customary charge when submitting claims. The usual and

customary charge is the provider's charge for providing the same service to persons not entitled to the program's benefits. For

providers who have not established usual and customary charges, the charge should be reasonably related to the provider's cost

for providing the service.

Providers may not discriminate against BadgerCare Plus or Medicaid members by charging a higher fee for the same service than

that charged to a private-pay patient.

For services requiring a member copay, providers should still indicate their usual and customary charge. The copay amount

collected from the member should not be deducted from the charge submitted. When applicable, ForwardHealth automatically

deducts the copay amount.

For most services, ForwardHealth reimburses the lesser of the provider's usual and customary charge, plus a professional

dispensing fee, if applicable, or the maximum allowable fee established.