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State of Wisconsin |
HISTORY |
The policy on this page is from a previous version of the handbook.
If it is determined that a member’s benefits have been incorrectly denied or terminated, restore his or her BadgerCare Plus from the date of the incorrect denial or termination through the time period that he or she would have remained eligible.
If the member was incorrectly denied or terminated for BadgerCare Plus with a premium obligation, allow the member to pick which months he or she would like to receive benefits. Collect all premiums owed for those prior months before certifying the member for the months he or she chose.
If a member already paid for a BadgerCare Plus covered service, inform the member that he or she will need to contact his or her provider to bill BadgerCare Plus for services provided during that time. A BadgerCare Plus provider must refund the amount that BadgerCare Plus will reimburse for the service. The provider may choose to refund up to the full amount billed to the member, but that decision is entirely optional.
If it is determined that a premium amount was incorrectly calculated for BadgerCare Plus and would result in a refund for the member, determine the correct premium amount for each month in which it was incorrect and report the error to the fiscal agent's BadgerCare Plus Unit. The fiscal agent will refund the amount of the premium the member overpaid. The report can be made either by:
When submitting a fax, write "Attn: BadgerCare Plus Premium Refunds”.
When reporting the refund to the BadgerCare Plus Unit, include the:
Indicate whether there is a hardship situation that requires the refund to be processed more quickly.
Occasionally, a BadgerCare Plus member is certified for retroactive Katie Beckett or SSI eligibility for a period of time in which they were also certified for BadgerCare Plus. If the BadgerCare Plus member paid a premium during this time frame, they are entitled to a refund of any BadgerCare Plus premiums that they paid during the retroactive Katie Beckett or SSI certification period.
This page last updated in Release Number: 10-02
Release Date: 10/29/07
Effective Date: 02/01/08
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