WI · guidance
Wis. ForwardHealth Online Handbook, Hospice, Topic #824
Services That Do Not Meet Program Requirements
As stated in Wis. Admin. Code § DHS 107.02(2), BadgerCare Plus and Wisconsin Medicaid may deny or recoup payment for
covered services that fail to meet program requirements.
Examples of covered services that do not meet program requirements include the following:
• Services for which records or other documentation were not prepared or maintained
• Services for which the provider fails to meet any or all of the requirements of Wis. Admin. Code § DHS 106.03, including,
but not limited to, the requirements regarding timely submission of claims
• Services that fail to comply with requirements or state and federal statutes, rules, and regulations
• Services that Wisconsin DHS (Department of Health Services), the PRO (Peer Review Organization) review process, or
BadgerCare Plus determines to be inappropriate, in excess of accepted standards of reasonableness or less costly
alternative services, or of excessive frequency or duration
• Services provided by a provider who fails or refuses to meet and maintain any of the enrollment requirements under Wis.
Admin. Code ch. DHS 105
• Services provided by a provider who fails or refuses to provide access to records
• Services provided inconsistent with an intermediate sanction or sanctions imposed by DHS
Provenance
- Source
- www.forwardhealth.wi.gov
- Retrieved
- 2026-10-02
- Edition
- forwardhealth-hospice-2026-10-01
- Content hash
287822ad0c3038091286756ba50b6537a494c9a736b197feaf53ccbe28bfcede
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