• Covered Services
  • Introduction
  • Definition
    • Introduction
    • Program Requirements
  • Emergency Services
  • Services Not Separately Reimbursable
  • Recipient Payment for Covered Services
• Noncovered Services
  • Introduction
  • Definition
  • Recipient Payment for Noncovered Services
    • Introduction
    • Missed Appointments
    • Translation Services
• Collecting Payment from Recipients
  • Introduction
  • Conditions That Must Be Met
• HealthCheck "Other Services"
  • Introduction
  • Prior Authorization
• Appendix
  • Appendix 1 — Services Not Covered by Wisconsin Medicaid
• PDF

Select a section » Certification and Ongoing Responsibilities Claims Information Coordination of Benefits Covered and Noncovered Services Informational Resources Managed Care Prior Authorization Recipient Eligibility

 

 

Covered and Noncovered Services

Collecting Payment from Recipients

Conditions That Must Be Met

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

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

Providers are strongly encouraged to obtain a written statement in advance documenting that the recipient 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 recipient with eyeglasses covered by Wisconsin Medicaid but then, upon the recipient’s request, provide and charge the recipient for anti-glare coating, which is a noncovered service. Charging the recipient 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.

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