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

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]