BadgerCare Plus & Medicaid SSI Provider Manual - Group Health ...

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BadgerCare Plus & Medicaid SSI Provider Manual - GHC of Eau Claire May 2012 IDENTIFICATION OF GROUP HEALTH MEMBERS: Group Health BadgerCare Plus, Group Health Medicaid SSI, Compcare BadgerCare Plus and Compcare Medicaid SSI members do not receive Insurance Identification cards from GHC. BadgerCare Plus and Medicaid SSI members are required to carry and present their ForwardHealth card (issued by Department of Health Services) when seeking services. DHS ForwardHealth Card IT IS ESSENTIAL THAT MEDICAID PROVIDERS VERIFY ENROLLMENT PRIOR TO EACH DATE OF SERVICE. The secure area of the ForwardHealth Portal offers real‐time member enrollment verification for all ForwardHealth programs. All Portal users can use this tool to determine the benefit plan(s) in which the member is enrolled or if the member is enrolled in a state‐contracted managed care program (for BadgerCare Plus and Medicaid members). The ForwardHealth Portal website can be found at www.ForwardHealth.wi.gov/ and is available 24 hours a day, seven days a week. Providers may also contact WiCall (formerly known as ForwardHealth Automatic Voice Response) at 1‐800‐947‐3544 for enrollment verification. WiCall is available 24 hours a day, seven days a week. To verify enrollment and benefits for Group Health and Compcare members, contact the GHC Provider Services Department directly at 1‐715‐552‐4333 or toll‐free at 1‐866‐563‐3020. Representatives are available from 8:00 a.m. to 5:00 p.m. Monday through Friday. Providers can also verify eligibility and benefit plan (i.e. Standard, Benchmark, SSI, Core) for GHC and Compcare members via the secure on‐line eligibility website* for providers. Primary care clinic assignment and other insurance information are also available via provider login. The Group Health website can be found at www.group‐health.com/ and is available 24 hours a day, seven days a week. *If you do not currently have on‐line eligibility access, please contact the Provider Services Department at 1‐866‐563‐3020 to establish an account. Execution of a Confidentiality Agreement is required for initial set‐up. IMPORTANT NOTE: In emergency situations, providers are required to treat the patient FOR medically necessary emergency care regardless of HMO affiliation. The provider should then bill the HMO that the patient is affiliated with. The State of Wisconsin requires that HMO’s reimburse for MEDICALLY NECESSARY emergency services. The patient should be instructed to follow-up with their HMO. [36]
BadgerCare Plus & Medicaid SSI Provider Manual - GHC of Eau Claire May 2012 DISENROLLMENT Members are automatically disenrolled from the HMO program if: 1. Their medical status code changes to a BadgerCare Plus subprogram that does not require enrollment in an HMO. 2. They become eligible for Medicare. 3. They lose eligibility. 4. They move out of the HMO’s service area. Members who move out of the HMO service area receive a new packet showing the HMO(s) available in the new area and the enrollment process begins again. If no HMO covers the member’s new area, s/he remains fee-forservice. [37]
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