Wisconsin Medicaid and BadgerCare
Department of Health and Family Services
November 2001
PDF of entire handbook (1.2 MB)

Family Care Guide Site Map

• Important Telephone Numbers  
  
  
• Preface
  
  
• General Information
  • What is Family Care?
  • The Role of Aging and Disability Resource Centers
  • The Role of Care Management Organizations
  • The Role of County Economic Support Units
  • The Role of the State
  • Family Care Pilots
    
    
• Member Information
  • Eligibility for Family Care
    • Functional Eligibility Criteria
    • Financial Eligibility Criteria
    • How Are Individuals Enrolled in Care Management Organizations?
  • Identification and Verification of Members Who Are Eligible for Medicaid
    • Identification
    • Verification Through the Automated Voice Response System
    • Verification Through Eligibility Verification Vendors
  • Members Who Are Not Eligible for Medicaid
    • Identification
    • Verification Through the Automated Voice Response System
    • Verification Through Eligibility Verification Vendors
  • Estate Recovery
    • Members and Estate Recovery
    • Providers and Estate Recovery
  • Member Complaints and Grievances
    • Provider Assistance for Member Complaints and Grievances
      

• Service Information
  • Provider Networks
    • Member Requests for Providers Not Affiliated With a Care Management Organization
  • Covered Services
    • Medicaid Services Included in the Family Care Benefit Package
    • Home and Community-Based Waiver Services Included in the Family Care Benefit Package
  • Services Not Included in the Family Care Benefit Package
  • Provision of Noncovered Services
  • Emergency and Urgent Care Services
    • Emergency Care
    • Urgent Care
    • 24-Hour Access to the Care Management Organization
  • Out-of-Area Care
  • Prior Authorization
    • Existing Medicaid Fee-for-Service Prior Authorization
    • Care Management Organization Authorization
      
      
• Billing for Medicaid-Eligible Members
  • Billing for Services Included in the Family Care Benefit Package
    • Medicare Crossover Claims
  • Billing for Medicaid Services Not Included in the Family Care Benefit Package
  • Split Billing 
  • Member Payment for Services
    • Copayment
    • Member Cost-Share
      • Medicaid Nursing Home Resident Liability
  • Provider Appeals
    
    
• Billing for Non-Medicaid-Eligible Members
  • Billing for Services Included in the Family Care Benefit Package
    • Medicare Crossover Claims
  • Billing for Services Not Included in the Family Care Benefit Package
  • Member Payment for Services
    • No Copayment
    • Member Cost-Share
  • Provider Appeals
    
    
• Appendix
  1. Care Management Organization Contact Numbers
  2. Aging and Disability Resource Centers
  3. Complaints, Grievances, and Appeals Contacts
  4. Medicaid Services Included and Not Included in the Family Care Benefit Package
  5. Eligibility and Covered Services Illustrations
     
     
• Glossary of Common Terms