WI · guidance
Wis. ForwardHealth Online Handbook, Hospice, Topic #844
Claims for Services Denied by Commercial Health
Insurance
If commercial health insurance denies or recoups payment for services that are covered by BadgerCare Plus and Wisconsin
Medicaid, the provider may submit a claim for those services. To allow payment in this situation, providers are encouraged to
follow the requirements (for example, request PA (prior authorization) before providing the service for covered services that
require PA). If the requirements are followed, ForwardHealth may reimburse for the service up to the allowed amount (less any
payments made by other health insurance sources).
Note: The provider is required to demonstrate that a correct and complete claim was denied by the commercial health insurance
company for a reason other than that the provider was out of network.
Provenance
- Source
- www.forwardhealth.wi.gov
- Retrieved
- 2026-10-02
- Edition
- forwardhealth-hospice-2026-10-01
- Content hash
4120658e9038c006df83fc09109c75b98e6cf13a75398f9753983d3ab71302a5
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