14-03 Version of 9.10 Questionable Items
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State of Wisconsin
Department of Health Services

HISTORY

The policy on this page is from a previous version of the handbook. 

9.10 Questionable Items

Information is questionable for BadgerCare Plus when:

 

  1. There are inconsistencies in the group’s oral or written statements.
  2. There are inconsistencies between the group’s claims and collateral contacts, documents, or prior records.

  3. The member or his or her representative is unsure of the accuracy of his or her own statements.

  4. The member has been convicted of Medicaid or BadgerCare Plus fraud or has legally acknowledged his or her guilt of member fraud.

  5. The member is a minor who reports that he or she is living alone. This does not apply to minors applying solely for Family Planning Services.

  6. The information provided is unclear or vague.

  7. CARES Worker Web (CWW) determines the case meets an automated Error Prone Profile.

9.10.1 Front End Verification

Front-End verification (FEV) is intensive verification of a case by a special unit or worker. Refer a group for FEV only when its characteristics meet a designated profile. See 12.3 FEV Case Application of the Income Maintenance Manual.

 

 

 

This page last updated in Release Number: 14-03

Release Date: 09/05/14

Effective Date: 09/28/14

The information concerning the BadgerCare Plus program provided in this handbook release is published in accordance with: Titles XI, XIX and XXI of the Social Security Act; Parts 430 through 481 of Title 42 of the Code of Federal Regulations; Chapter 49 of the Wisconsin Statutes; and Chapters HA 3, DHS 2 and 101 through 109 of the Wisconsin Administrative Code.

Publication Number: P-10171