WI · guidance
Wis. ForwardHealth Online Handbook, Hospice, Topic #769
Services Requiring Commercial Health Insurance Billing
If ForwardHealth indicates that the member has other commercial health insurance, the provider is required to bill the following
services to commercial health insurance before submitting claims to ForwardHealth:
• Ambulance services, if provided as emergency services
• Anesthetist services
• Audiology services, unless provided in a nursing home or SNF (skilled nursing facility)
• Behavioral treatment
• Blood bank services
• Chiropractic services
• Dental services
• DME (durable medical equipment) (rental or purchase), prosthetics, and hearing aids if the billed amount is over $10 per
item
• Home health services (excluding PC (personal care) services)
• Hospice services
• Hospital services, including inpatient or outpatient
• Independent nurse, nurse practitioner, or nurse midwife services
• Laboratory services
• Medicare-covered services for members who have Medicare and commercial health insurance
• In-home mental health/substance abuse treatment services for children (HealthCheck Other Services) rendered by
providers at the master's degree level, doctoral level, and psychiatrist level
• Outpatient mental health/substance abuse services
• Mental health/substance abuse day treatment services, including child and adolescent day treatment
• Narcotic treatment services
• PT (physical therapy), OT (occupational therapy), and SLP (speech and language pathology) services, unless provided in a
nursing home or SNF
• Physician assistant services
• Physician services, including surgery, surgical assistance, anesthesiology, or any service to a hospital inpatient (however,
physician services provided to a woman whose primary diagnosis indicates a high-risk pregnancy do not require
commercial health insurance billing)
• Pharmacy services for members with verified drug coverage
• Podiatry services
• PDN (private duty nursing) services
• Radiology services
• RHC (rural health clinic) services
• Skilled nursing home care, if any DOS (date of service) is within 120 days of the date of admission; if benefits greater than
120 days are available, the nursing home is required to continue to bill for them until those benefits are exhausted
• Vision services over $50, unless provided in a home, nursing home, or SNF
If ForwardHealth indicates the member has other vision coverage, the provider is required to bill the following services to
commercial health insurance before submitting claims to ForwardHealth:
• Ophthalmology services
• Optometrist services
If ForwardHealth indicates the member has Medicare supplemental plan coverage, the provider is required to bill the following
services to commercial health insurance before submitting claims to ForwardHealth:
• Alcohol, betadine, and/or iodine provided by a pharmacy or medical vendor
• Ambulance services
• Ambulatory surgery center services
• Breast reconstruction services
• Chiropractic services
• Dental anesthesia services
• Home health services (excluding PC services)
• Hospital services, including inpatient or outpatient
• Medicare-covered services
• Osteopath services
• Physician services
• Skilled nursing home care, if any DOS is within 100 days of the date of admission; if benefits greater than 100 days are
available, the nursing home is required to continue to bill for them until those benefits are exhausted
ForwardHealth has identified services requiring Medicare Advantage billing.
Provenance
- Source
- www.forwardhealth.wi.gov
- Retrieved
- 2026-10-02
- Edition
- forwardhealth-hospice-2026-10-01
- Content hash
9ecc443d3d60e18fe619597a33c346cd3048f62f85025a38eee4a62a728e89e6
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