Medical Billing Company in Wisconsin | Built for BadgerCare Plus's Dual Billing Paths

Wisconsin delivers most BadgerCare Plus benefits through a large field of contracted HMOs, including Children's Community Health Plan, Dean Health Plan, Group Health Cooperative of Eau Claire, Independent Care Health Plan, Managed Health Services, MercyCare, and several others, while members in counties without managed care options receive coverage through fee-for-service billed directly to the state. Wisconsin has not adopted standard ACA Medicaid expansion. Instead, the state uses a federal waiver to cover adults up to 100 percent of the federal poverty level under BadgerCare Plus, leaving a coverage gap for adults earning between 100 and 138 percent FPL who must use the federal marketplace instead. Income limits for 2026 were updated February 1, slightly later than most states. Wisconsin does not publish a single downloadable fee schedule. DHS pays providers the lesser of their billed charge or the state's maximum allowable fee, and providers contracted with HMOs like MHS Health Wisconsin or Molina Healthcare must consult that plan's own provider manual since HMO negotiated rates can differ from the state fee-for-service schedule. Certain services, such as chiropractic care and dental, revert to the fee-for-service schedule even for patients enrolled in an HMO. Long-term services and supports run through a separate structure called Family Care, delivered by its own MCOs and kept apart from a member's regular medical, dental, and prescription coverage under BadgerCare or EBD Medicaid. Mediknocx's billing team confirms which pathway, HMO or fee-for-service, applies to each service before submitting a Wisconsin Medicaid claim.