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Preface

This Physician Services Handbook is issued to all Medicaid-certified physician services providers. The information in this handbook applies to Medicaid and BadgerCare.

Medicaid is a joint federal and state program established in 1965 under Title XIX of the federal Social Security Act. Wisconsin Medicaid is also known as the Medical Assistance Program, WMAP, MA, Title XIX, and T19.

BadgerCare extends Medicaid coverage through a Medicaid expansion under Titles XIX and XXI. The goal of BadgerCare is to fill the gap between Medicaid and private insurance without supplanting or crowding out private insurance. BadgerCare recipients receive the same benefits as Medicaid recipients, and their health care is administered through the same delivery system.

Wisconsin Medicaid and BadgerCare are administered by the Department of Health and Family Services (DHFS). Within the DHFS, the Division of Health Care Financing is directly responsible for managing Wisconsin Medicaid and BadgerCare.

Unless otherwise specified, all information contained in this and other Medicaid publications pertains to services provided to recipients who receive care on a fee-for-service basis. Refer to the Managed Care section of the All-Provider Handbook for information about state-contracted managed care organizations.

Handbook Organization

This Physician Services Handbook consists of the following sections:

• Anesthesia.
• Laboratory and Radiology.
• Medicine and Surgery.

All-Provider Handbook

All Medicaid-certified providers receive a copy of the All-Provider Handbook, which includes the following sections:

• Certification and Ongoing Responsibilities.
• Claims Information.
• Coordination of Benefits.
• Covered and Noncovered Services.
• Informational Resources.
• Managed Care.
• Prior Authorization.
• Recipient Eligibility.

Providers are required to refer to the All-Provider Handbook for information about these topics.

Wisconsin Medicaid and BadgerCare Web Sites

Publications (including provider handbooks and Wisconsin Medicaid and BadgerCare Updates), maximum allowable fee schedules, telephone numbers, addresses, and more information are available on the following Web sites:

• dhs.wisconsin.gov/medicaid/.
• dhs.wisconsin.gov/badgercareplus/.

Publications

Medicaid publications apply to both Wisconsin Medicaid and BadgerCare. Publications interpret and implement the laws and regulations that provide the framework for Wisconsin Medicaid and BadgerCare. Medicaid publications provide necessary information about program requirements.

Legal Framework

The following laws and regulations provide the legal framework for Wisconsin Medicaid and BadgerCare:

• Federal Law and Regulation:
• Law — United States Social Security Act;
  Title XIX (42 US Code ss. 1396 and following) and Title XXI.
• Regulation — Title 42 CFR Parts 430-498 and Parts 1000-1008 (Public Health).

• Wisconsin Law and Regulation:
• Law — Wisconsin Statutes: 49.43-49.499 and 49.665.
• Regulation — Wisconsin Administrative Code, Chapters HFS 101-109.

Laws and regulations may be amended or added at any time. Program requirements may not be construed to supersede the provisions of these laws and regulations.

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Physician Services Handbook
December 2005