WI · guidance
Wis. ForwardHealth Online Handbook, Hospice, Topic #603
Services Not Requiring Commercial Health Insurance
Billing
Providers are not required to bill commercial health insurance sources before submitting claims for the following:
• Case management services
• CCS (Comprehensive Community Services)
• Crisis Intervention services
• CRS (Community Recovery Services)
• CSP (Community Support Program) services
• Family planning services
• In-home mental health/substance abuse treatment services for children (HealthCheck Other Services) rendered by
providers at the less than bachelor's degree level, bachelor's degree level, QTT (qualified treatment trainee) level, or
coinsurance, copay, blood deductible, or psychiatric reduction. Indicate the amount paid by commercial
health insurance to the provider or to the insured.
OI-D DENIED by commercial health insurance following submission of a correct and complete claim. Do not use
this code unless the claim was actually billed to the commercial health insurer.
OI-Y YES, the member has commercial health insurance coverage, but it was not billed for reasons including, but
not limited to, the following:
• The member denied coverage or will not cooperate.
• The provider knows the service in question is not covered by the carrier.
• The member's commercial health insurance failed to respond to initial and follow-up claims.
• Benefits are not assignable or cannot get assignment.
• Benefits are exhausted.
certified psychotherapist level
• Personal care services
• PNCC (prenatal care coordination) services
• Preventive pediatric services
• SMV (specialized medical vehicle) services
Provenance
- Source
- www.forwardhealth.wi.gov
- Retrieved
- 2026-10-02
- Edition
- forwardhealth-hospice-2026-10-01
- Content hash
43718b80f3f665392db6f025ec06d62d4e9684c86d35e6576416b53054112770
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