The reimbursement and capitation rates webpage contain information to assist Managed Care Organization (MCO) in receiving reimbursement for services rendered under the Department of Health Services (DHS) contract. Questions regarding the information presented should be directed to DHSDMSBFM@dhs.wisconsin.gov
This grid provides summary information on the Department’s reimbursement policy of the Medicaid contract. Information on this grid includes the source of the reimbursement file, the frequency, the method and type of reimbursement, and where reports showing payments or recoupments are located.
This guide is designed to assist MCOs in understanding the HPE Electronic Funds Transfer (EFT) system and being able to track any EFT related activity.
This guide is designed for MCOs to report the Wisconsin specific costs associated with Section 9010 of the Affordable Care Act (ACA) Health Insurance Fee (HIF).
This guide is designed to support the Managed Care Organizations (MCOs) in reporting of the maternity deliveries for reimbursement in the Badgercare Plus program. Each pregnant member is covered for all care related to the pregnancy, delivery and any complications that may occur during pregnancy and up to 60 days postpartum. The Maternity Kick Payment is made to the MCO outside of the monthly Capitation payment
This guide is designed to be used with the Capitation Load Tables below.
Below are resources for the Dental Pilot program for enhanced reimbursement to Brown, Marathon, Polk, and Racine County.
The matrix below contain the maximum fee rates for orthodontic and manually priced dental services. Rates for Non-Dental Pilot and Dental Pilot counties are listed as a resource for MCOs.
The Accounting Reason Codes contain the HPE assigned four digit code and description for any financial transaction between the MCO and the State.
The file contains Wisconsin rate region for the BadgerCare Plus and SSI Managed Care Programs.