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

BadgerCare Plus & Medicaid SSI Provider Manual - GHC of Eau Claire May 2012
COORDINATION OF CARE MOU’S
Health Plans are required by the Department of Human Services to ensure the coordination of care for their
members. Because of this requirement, GHC/Compcare asks Counties and Primary Care Clinics (PCC) to
address the coordination of care for HealthCheck exams with a signed Memorandum of Understanding (MOU).
Negotiating an MOU is strictly between the County and Clinic, and either party may decline to sign. However,
having an MOU in place encourages the coordination of care of the client, eliminates the duplication of services,
and saves time and money.
A signed MOU is only required when the County submits claims for HealthCheck exams. MOUs
must be in place between the County Department and client’s Primary Care Clinic (PCC) before the
County will be reimbursed for HealthCheck EXAMS. Either fax a copy of the signed MOU to
GHC/Compcare at: 715-836-7683, or mail a copy to: Provider Relations, P.0. Box 3217, Eau Claire, WI
54702-3217.
An MOU is NOT required between the County and PCC if the County only performs components of
the HealthCheck Exam (e.g. immunizations, blood lead screens, dental fluoride varnish, etc.) and does
not perform the HealthCheck exam.
COPAYMENT INFORMATION
BadgerCare Plus:
Standard Plan: Copayments will not apply for Group Health and Compcare BadgerCare Plus clients
enrolled in the Standard Plan. The County’s reimbursement will not be reduced by the copayment amount.
Please do not attempt to collect copayments from BadgerCare Plus Standard Plan Group Health and
Compcare HMO clients.
Benchmark: Copayments may apply for clients enrolled in the Benchmark Plan; therefore, it is crucial for
providers to verify a client’s enrollment prior to providing services to determine Plan coverage.
Core Plan (Childless Adults): Copayments will apply for clients enrolled in the Core Plan. Copayment
amounts will vary based on the client’s income level.
All copayments are waived for clients with incomes up to 100% FPL.
For clients with incomes from 100-200% FPL, all copayments are waived except for the following
benefits:
Inpatient Hospital
Outpatient Hospital
Emergency Room (ER)
Medicaid SSI Managed Care
Medicaid SSI Managed Care clients do not have copayments for covered medical services. The County’s
reimbursement will not be reduced by the copayment amount. Please do not attempt to collect copayments
from Medicaid SSI Managed Care clients.
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