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HMO Administrators


This page provides resources and general information for staff and administrators of BadgerCare Plus or Medicaid SSI HMOs.

For information specific to members, visit the Wisconsin Department of Health Services(DHS) site.


Initial Readiness Assessment for the BadgerCare Plus and Medicaid SSI HMO Program
A completed readiness assessment is required to become a BadgerCare Plus or Medicaid SSI HMO.
Contract for BadgerCare Plus and/or Medicaid SSI HMO Services
A signed contract is required to become a BadgerCare Plus or Medicaid SSI HMO.
Enrollment Counts and Population Explanations
The Medicaid managed care enrollment reports provide a retrospective (rather than prospective) view of Wisconsin managed care enrollment information. The reports reflect a six-month rolling time frame and have been updated to provide enrollment counts by recipient county of residence.
Medical Status Codes
This page provides a list of member medical status codes eligible for BadgerCare Plus HMO or SSI HMO enrollment.
Contracts and Amendments
BadgerCare Plus and Medicaid SSI HMOs are expected to adhere to their contracts.
ForwardHealth Updates
ForwardHealth Updates announce changes in policy and coverage, prior authorization requirements, and claim submission requirements. They communicate new initiatives from DHS or new requirements from the Centers for Medicare & Medicaid Services and the Wisconsin state legislature.
ForwardHealth Online Handbook
Providers should refer to the ForwardHealth Online Handbook for current ForwardHealth policy and provider-specific information for services and benefits.
Report Matrix
This table lists all reports and layouts sent by DHS to HMOs.
HMO Report List
This document lists all contract-specified reports due from HMOs to DHS on a daily, monthly, quarterly, annual, or other basis.
HMO Provider Network Universe
The following link contains file submission specifications and data dictionaries sent by DHS to HMOs.
The HMO BadgerCare Plus and Medicaid SSI Quality Page contains quality-related documents for HMOs and providers including but not limited to:
HMO Quality Guide
View current and past HMO Quality Guides.
Performance Improvement Projects (PIPs)
See resources related to HMO PIPs such as the External Quality Review Organization (EQRO) Portal User Guide, PIP Proposal Worksheet, and current and former projects.
HMO Report Cards
See current and past report cards for the HMOs.
External Quality Review Organization Annual Technical Reports
See current and past reports by the EQRO that summarize findings related to quality, timeliness, and access to health care provided by organizations to Medicaid beneficiaries.
Quality Strategy
The current and past Quality Strategy documents can be viewed at the Medicaid Managed Care Quality Strategy Collection, P-02156.
Encounters and Reporting
The Encounter Data Reporting webpage contains information to assist HMOs in reporting and receiving data associated with their DHS contract.
Reimbursement and Capitation
The Reimbursement and Capitation rates webpage contains information to assist HMOs in receiving reimbursement for services rendered under the DHS contract.
ForwardHealth Trainings
This catalog describes trainings and educational resources for providers and other stakeholders.
User Guides
ForwardHealth user guides and instruction sheets provide ForwardHealth Portal users with step-by-step instructions and screen shots to help navigate Portal functionality.
State of Wisconsin Contact Information
This table contains DHS contact information, including advocates, HMO Ombuds, ForwardHealth Member Services, HMO support, and ForwardHealth Portal Help Desk.
Managed Care Medical Homes
This page provides resources for each of the three medical home programs which serve Wisconsin’s Medicaid managed care programs.
Obstetric Medical Homes (OBMH)
View resources for HMOs and providers of OBMH’s prenatal and postpartum care to BadgerCare Plus and Medicaid SSI members.
HIV/AIDS Health Home
Learn more about the HIV/AIDS health home that helps ensure all BadgerCare Plus and Medicaid SSI members diagnosed with HIV or AIDS have access to appropriate specialists and Medicaid-covered services.
Care4Kids Foster Care Medical Home
Learn more about the Care4Kids Foster Care Medical Home, a Medicaid program that provides comprehensive, coordinated care for children in out-of-home care that reflects trauma-informed principles and recognizes the unique needs of these children.

What's New?
A summary of what is new for managed care organizations:


•Upcoming Changes for Noncitizen Member Eligibility
 •2027 BadgerCare Plus and Medicaid SSI HMO D-SNP Contract
 •2025 MetaStar EQR Annual Technical Report
 •2026 HMO PIP Topics, Aims, and Interventions
 •2026 BadgerCare Plus and Medicaid SSI HMO Contract
 •2024 HMO Report Card
 •2026 Care4Kids Quality Guide
 •2026 HMO Quality Guide
 
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