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Provider Manual

Non-covered Services

Last Updated on August 20, 2021

Non-covered Services

Security Health Plan requires providers to follow ForwardHealth guidelines and the Security Health Plan provider contract when billing BadgerCare members for services.

ForwardHealth Guidelines:
Member payment for non-covered services
A provider may collect payment from a member for non-covered services if certain conditions are met. Providers may not collect payment from a member, or authorized person acting on behalf of the member, for certain non-covered services or activities provided in connection with covered services, including the following:

  • Charges for missed appointments
  • Charges for telephone calls
  • Charges for time involved in completing necessary forms, claims, or reports
  • Translation services

Conditions that must be met to bill the member:
A member may request a non-covered service, a covered service for which PA was denied (or modified), or a service that is not covered under the member's limited benefit category. The charge for the service may be collected from the member if the following conditions are met prior to the delivery of that service:

  • The member accepts responsibility for payment.
  • The provider and member make payment arrangements for the service.

Providers are strongly encouraged to obtain a written statement in advance documenting that the member has accepted responsibility for the payment of the service.

Furthermore, the service must be separate or distinct from a related, covered service. For example, a vision provider may provide a member with eyeglasses but then, upon the member's request, provide and charge the member for anti-glare coating, which is a noncovered service. Charging the member is permissible in this situation because the anti-glare coating is a separate service and can be added to the lenses at a later time.

For information on non-covered services see Physicians Handbook

  • Click Online Handbooks
  • Choose I Accept radio button  and  click Submit Agreement
  • Under Choose a program, select BadgerCare Plus and Medicaid
  • Under Choose a service area, select Physician
  • Select Covered and Noncovered Services
  • Choose Noncovered Services
  • Select Member Payment for Noncovered Services

For information on conditions that must be met to bill the member see Physicians Handbook

  • Click  Online Handbooks
  • Choose  I Accept radio button  and  click Submit Agreement
  • Under User Type, select Provider
  • Under  Choose a program, select BadgerCare Plus and Medicaid
  • Under  Choose a service area, select Physician
  • Select  Reimbursement
  • Choose  Collecting Payment From Members
  • Select  Conditions That Must Be Met

Summary of DHS Requirements noted in SHP Contract – BadgerCare Plus Compliance Exhibit:
If a Member agrees in writing to pay for Non-Covered Services, then Security Health Plan, a Security Health Plan provider or the Provider can bill the member for Non-Covered Services. The standard release form signed by the Member at the time of services does NOT relieve Security Health Plan and the Provider from the prohibition against billing a Medicaid Member in the absence of a knowing assumption of liability for a Non-Medicaid Covered Service. The form or other type of acknowledgement relevant to BadgerCare Plus or Medicaid SSI Member liability must specifically state the admissions, services or procedures that are not covered by BadgerCare Plus or Medicaid SSI in accordance with Article III(J).