WI · guidance
Wis. ForwardHealth Online Handbook, Hospice, Topic #518
Definition of Good Faith Claims
A good faith claim may be submitted when a claim is denied due to a discrepancy between the member's enrollment information in
the claims processing system and the member's actual enrollment. If a member presents a temporary identification card for
BadgerCare Plus or Family Planning Only Services, the provider should check the member's enrollment via Wisconsin's EVS
(Enrollment Verification System) and, if the enrollment is not on file yet, make a photocopy of the member's temporary
identification card.
When a member presents a temporary ID card for EE (Express Enrollment) in BadgerCare Plus or Family Planning Only Services
but the member's enrollment is not on file yet in the EVS, the provider should check enrollment again in two days or wait one
week to submit a claim to ForwardHealth. If, after two days, the EVS indicates that the member still is not enrolled or the claim is
denied with an enrollment-related EOB (Explanation of Benefits) code, the provider should contact Provider Services for
assistance.
When a member who received a real-time eligibility determination presents a temporary ID card but the member's enrollment is
not on file yet in the EVS, the provider should wait up to one week to submit a claim to ForwardHealth. If the claim is denied with
an enrollment-related EOB code, the provider should contact Provider Services for assistance.
Provenance
- Source
- www.forwardhealth.wi.gov
- Retrieved
- 2026-10-02
- Edition
- forwardhealth-hospice-2026-10-01
- Content hash
4775de3d62afc5a31165c1662207a03b09d27933427be7311904adabe1b234e9
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