Recently, we identified a discrepancy between the My Choice Wisconsin by Molina Healthcare, Inc. (MCW) Prior Authorization Look-Up tool and our Prior Authorization Request Guide regarding Home Health Services for the Family Care Partnership line of business. This may have resulted in inaccurate claim denials.

MCW will be adjusting home health service claims that were properly billed but denied due to missing prior authorization for services provided between January 1, 2025 and April 30, 2025. No action is required on your part for these claims.

Provider Action Needed:

For services provided on or after May 1, 2025, please refer to the updated Prior Authorization Request Guide and submit prior authorization for home health care services as needed. The updated guide is available on our website at https://mychoicewi.org/wp-content/uploads/20450_MHI_Q1_2025_PA-Guide-Request-Form_MEDICAID_MCW.pdf.