|Program Name: ||BadgerCare Plus and Medicaid ||Handbook Area: ||Physician |
Reimbursement : Amounts
Maximum allowable fee information is available on the ForwardHealth Portal in the following forms:
- Interactive fee schedule
- Downloadable fee schedule in TXT files
Certain fee schedules are interactive. Interactive fee schedules provide coverage information as well as maximum allowable fees for all reimbursable procedure codes. The downloadable TXT files are free of charge and provide basic maximum allowable fee information for BadgerCare Plus by provider service area.
A provider may request a paper copy of a fee schedule by calling Provider Services.
Providers may call Provider Services in the following cases:
- Internet access is not available.
- There is uncertainty as to which fee schedule should be used.
- The appropriate fee schedule cannot be found on the Portal.
- To determine coverage or maximum allowable fee of procedure codes not appearing on a fee schedule.
Targeted Reimbursement Rate Increase
In accordance with a provision of the 2015-17 biennial state budget (2015 Wisconsin Act 55), ForwardHealth implemented a targeted reimbursement rate increase for pediatric dental care and certain adult dental services rendered in Brown, Marathon, Polk, and Racine counties.
ForwardHealth reimburses the lesser of the provider's billed amount or the increased reimbursement rate. The maximum daily reimbursement rate policy applies only for services eligible for the rate increase.
ForwardHealth has established a
Targeted Reimbursement Rate Maximum Allowable Fee Schedule for all impacted ForwardHealth-allowable CDT procedure codes. These rates are not part of ForwardHealth's interactive fee schedule.