Prior Authorization in Wisconsin
Soft Home Global provides authorizations submitted ahead of the date of service and chased to a decision for Wisconsin practices and billing companies at $1,900 per seat per month. Full time, worked during Wisconsin business hours, inside your own system.
What is specific to Wisconsin
BadgerCare Plus enrols most members through contracted HMOs, and Wisconsin's commercial market is unusually fragmented, with several provider-sponsored regional plans rather than one carrier holding the bulk of the business.
Wisconsin’s Medicaid program is BadgerCare Plus (Wisconsin Medicaid). Practices with a meaningful BadgerCare Plus (Wisconsin Medicaid) mix usually need it worked as its own queue rather than mixed into commercial follow-up, because the submission path, the timely filing window and the appeal route are all different.
Medicare here is adjudicated by National Government Services, jurisdiction J6 — shared with Illinois and Minnesota, but not with Iowa (WPS) or Michigan (WPS). CMS publishes the jurisdictions; checked September 2026.
What a prior authorization seat does in Wisconsin
Submitted before the date of service and chased through the payer's decision window.
An authorisation found after the visit is a write-off, not a denial to appeal. In Wisconsin the work is submitting ahead of scheduling and chasing the decision, against a payment clock that starts only once a clean claim lands.
- Authorizations submitted ahead of scheduling, not after
- Status chased rather than waited on
- Peer-to-peer reviews scheduled when required
- Clinical documentation gathered before submission
- Expiring authorizations flagged before they lapse
- Worked during Wisconsin business hours, not queued overnight
For the statute behind all of this — Wisconsin’s prompt-pay deadline, its Medicaid filing limit, and the wrinkle that catches people out here — see the Wisconsin billing page.
BadgerCare Plus (Wisconsin Medicaid), in practice
BadgerCare Plus is delivered mainly through HMOs with county-limited service areas, with fee-for-service as the fallback; verbatim: "Most people who get BadgerCare Plus get it through HMOs (health maintenance organizations). These are insurance companies that offer services from select providers. ... If you do not choose an HMO by the due date, we pick one for you." Thirteen HMOs are currently listed: Anthem Blue Cross and Blue Shield, Chorus Community Health Plans, Dean Health Plan, Group Health Cooperative of Eau Claire, Group Health Cooperative of South Central Wisconsin, Independent Care Health Plan (iCare), MercyCare Insurance Company, MHS Health Wisconsin, Molina Health Care, Network Health Plan, Quartz, Security Health Plan Wisconsin, and UnitedHealthcare of Wisconsin — only Anthem, MHS Health Wisconsin and UnitedHealthcare cover all counties, so the correct plan depends on the member's county. Source: dhs.wisconsin.gov
Wisconsin has no workers' compensation medical fee schedule (outside pharmacy). Disputed WC fees are judged by the Department of Workforce Development against a certified fee database for the provider's geographic area, and the PROVIDER — not the insurer — carries a hard six-month deadline to open the dispute. Verbatim: "The provider must file with the department within six (6) months from the date they first received notice from the insurer, or self-insured employer, refusing to pay the provider's bill", and the insurer's answer must include "Information from a certified data base on fees charged by other providers for comparable services or procedures which clearly demonstrates that the fee in dispute is beyond the formula amount for the service or procedure within the provider's geographical area" (Wis. Stat. § 102.16(2); Wis. Admin. Code DWD 80.72). Practical effect: WC underpayments in Wisconsin are won or lost on a 6-month clock and on database comparables, not on a published fee schedule. Source: dwd.wisconsin.gov
For authorisations it decides who you ask. A carve-out means the rules, the portal and the turnaround belong to a different administrator from the one handling the rest of the member’s care, and an authorisation obtained from the wrong one is not an authorisation.
Working Wisconsin hours
Wisconsin runs on Central time, 11 hours behind our floor in Rawalpindi. To be at a desk for your nine to five, the shift here runs 8pm to 4am, and 7pm to 3am once the clocks go forward. Pakistan does not observe daylight saving, so the shift moves on this side rather than yours.
That is the part that decides whether follow-up happens at all: a payer’s phone lines are open on Wisconsin hours and nobody else’s.
What it costs in Wisconsin
$1,900
Per seat, per month, in US dollars — $22,800 a year for one full-time person, forty hours a week, on Wisconsin hours. No annual contract, no percentage of collections, no setup fee and no software to buy. Seat prices across all roles in Wisconsin run $1,500 to $2,500; the full list is published.
That is the entire invoice. Run your own figures against a percentage vendor or a hire rather than take ours.
Getting started in Wisconsin
About a week from a signed agreement to a person working your queue, and that week of training is not billed on top. The week, step by step, and what is signed before anyone has access.
If working with staff outside the United States is new to your practice, see how a medical billing company structures that seat and why offshore medical billing does not have to mean losing visibility into the work.
Questions
Do you work with Wisconsin practices?
Yes. Wisconsin accounts are worked during Wisconsin office hours rather than queued overnight, because a payer's phone lines are open then and at no other time.
What is different about Wisconsin?
BadgerCare Plus enrols most members through contracted HMOs, and Wisconsin's commercial market is unusually fragmented, with several provider-sponsored regional plans rather than one carrier holding the bulk of the business.
Which Medicare Administrative Contractor covers Wisconsin?
National Government Services, the A/B MAC for jurisdiction J6. Medicare Advantage and commercial plans run their own authorizations; for traditional Medicare, the hospital outpatient services on CMS’s prior authorization list are reviewed by this MAC.
When does a Wisconsin payer have to pay a clean claim?
30 days after the insurer is furnished written notice of the loss and its amount (Wis. Stat. § 628.46(1)). This is a general insurance prompt-pay provision — the section does not set separate electronic vs. paper clean-claim deadlines; a parallel 30-day rule at § 628.46(2m) runs from receipt of the chiropractor's clinical documentation. The authorization gets the service approved; this is the deadline for paying the claim that follows it, once that claim is clean.
How fast must BadgerCare Plus (Wisconsin Medicaid) decide a prior authorization?
Under the federal CMS-0057-F rule, from 1 January 2026: 72 hours for an expedited request and seven calendar days for a standard one, for Medicaid fee-for-service and Medicaid managed care plans alike, counted in calendar time whether the request went by portal, fax or phone. The calculator at softhomeglobal.com/prior-auth-deadline works out the date.
How much does prior authorization cost in Wisconsin?
$1,900 per seat per month — $22,800 a year for a full-time person, forty hours a week. Every seat price is published at softhomeglobal.com/pricing.
What hours will somebody actually be working our Wisconsin queue?
Wisconsin is on Central time, 11 hours behind Rawalpindi. The shift here runs 8pm to 4am so your seat is at a desk for your full working day, shifting to 7pm to 3am while daylight saving is in force — Pakistan does not observe it, so the change happens on our side.
Do you handle BadgerCare Plus (Wisconsin Medicaid) as well as commercial payers?
Yes, and as its own queue rather than mixed into commercial follow-up. BadgerCare Plus (Wisconsin Medicaid) has its own submission path, its own filing window and its own appeal route, and working it in the same worklist as commercial claims is how the deadlines get missed.
Is this a percentage of what you collect?
No — a flat monthly rate per seat, published at softhomeglobal.com/pricing. A percentage bills you most in your best month and points the vendor at the easy accounts.
More for Wisconsin
Next step
One seat on your Wisconsin work
Twenty minutes on a call is enough to tell whether this fits. If it does not, I will say so.
Or write to ops@softhomeglobal.com