WI · guidance
Wis. ForwardHealth Online Handbook, Hospice, Topic #86
Member Payment for Covered Services
Under state and federal laws, a Medicaid-enrolled provider may not collect payment from a member, or authorized person acting
on behalf of the member, for covered services even if the services are covered but do not meet program requirements. Denial of a
claim by ForwardHealth does not necessarily render a member liable. However, a covered service for which PA (prior
authorization) was denied is treated as a noncovered service. (If a member chooses to receive an originally requested service
instead of the service approved on a modified PA request, it is also treated as a noncovered service.) If a member requests a
covered service for which PA was denied (or modified), the provider may collect payment from the member if certain conditions
are met.
If a provider collects payment from a member, or an authorized person acting on behalf of the member, for a covered service, the
provider may be subject to program sanctions including termination of Medicaid enrollment.
Provenance
- Source
- www.forwardhealth.wi.gov
- Retrieved
- 2026-10-02
- Edition
- forwardhealth-hospice-2026-10-01
- Content hash
853fb2178af9bdd293f7811cebd53005271a4d28aa394c0c58f67991c79df0f4
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