BWC resubmits outpatient medication rules with unchanged compound provisions, sets February 2026 start date, and reopens public comments.
BWC resubmits outpatient medication rules with unchanged compound provisions, sets February 2026 start date, and reopens public comments.
Random audits will review timely and accurate benefit delivery, medical reimbursement, and the reporting of electronic data to the DWC.
Public comments regarding fee and payment rules, medical services, and managed care organizations must be submitted by September 30th.
Provider EORs would require contract-specific info. Not providing a requested contract in 30 days allows bills to be reprocessed at full fee schedule rates.
The BWC withdrew its proposed outpatient medication reimbursement rules for self-insured employer claims due to a technical error.
Among other updates, Wisconsin will implement a hospital fee schedule by July 1, 2027.
The update includes a revised MUE value for certain HCPCS codes, retroactive to October 1, 2024.
Employers or insurers would be required to provide immediate medical treatment. If a claim is not compensable, they could seek reimbursement.
Healthesystems attended the meeting to capture key discussion updates.
These disputes would qualify for independent bill review, and contracts must be presented when justifying payments below fee schedule.
Key provisions address billing disputes over contractual discounts.
Among other changes, the bill would ban effective rate contracts, making it difficult to forecast drug costs.
Timelines for bill submission and payment would begin only after a claim is accepted as compensable.
