New Payment Integrity Review Program

The Wisconsin Department of Health Services (DHS) Office of the Inspector General (OIG) is implementing a new Payment Integrity Review (PIR) program for ForwardHealth providers for claims submitted on and after April 1, 2023. This program:

• Allows the OIG to review claims prior to payment.
• Requires providers to submit all required documentation to support approval and payment of PIR-selected claims.

The goal of the PIR program is to further safeguard the integrity of DHS-administered public assistance programs, such as BadgerCare Plus and Wisconsin Medicaid, from fraud, waste, and abuse.

For more information about the PIR program, refer to ForwardHealth Update 2023-05, titled “New Payment Integrity Review Program.”