General Information
Recipient Information
Verifying Recipient Eligibility
Wisconsin Medicaid providers should verify recipient eligibility and identify any limitations to the recipient’s coverage before providing services.
Recipients in the following benefit categories have limitations in their Medicaid coverage:
- Family Planning Waiver Program.
- Illegal (undocumented) aliens. (Refer to the Physician Services Handbook for a reproducible copy of the Certification of Emergency for Non-U.S. Citizens form [PDF], HCF 1162.)
- Presumptive Eligibility for Pregnant Women Program.
- Qualified Medicare Beneficiary only.
- Qualified Working Disabled Individual.
- SeniorCare.
- Specified Low-Income Medicare Beneficiary only.
- Tuberculosis-related.
Eligibility information for specific recipients is available from Wisconsin Medicaid’s Eligibility Verification System (EVS). The EVS is used by providers to verify recipient eligibility, including whether the recipient is enrolled in a Medicaid HMO, has commercial health insurance coverage, or is in a restricted benefit category. Providers can access Medicaid’s EVS a number of ways, including:
- Automated Voice Response system.
- Magnetic stripe card readers.
- Personal computer software.
- Provider Services.
- Direct Information Access Line with Updates for Providers (Dial-Up).
Refer to the Medicaid Web site at dhs.wisconsin.gov/medicaid/ for more information about these restricted benefit categories and ways to verify recipient eligibility. For telephone numbers regarding recipient eligibility, refer to the page of Important Telephone Numbers at the beginning of this handbook.
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Chiropractic Services Handbook
PHC 1306, October 2004