2013 Wisconsin Statutes & Annotations
149. Health insurance risk-sharing plans.
149.142 Provider payment rates.
149.142 Provider payment rates.
(1) Establishment of rates. The authority shall establish provider payment rates for covered expenses that consist of the usual and customary payment rates, as determined by the authority, for the services and articles provided plus an adjustment determined by the authority. The adjustments to the usual and customary rates shall be sufficient to cover the portion of plan costs specified in s. 149.143 (1) (c) and (2) (b).
(2m) Payment is payment in full. Except for copayments, coinsurance, or deductibles required or authorized under the plan, a provider of a covered service or article shall accept as payment in full for the covered service or article the payment rate determined under sub. (1) and may not bill an eligible person who receives the service or article for any amount by which the charge for the service or article is reduced under sub. (1).
History: 1999 a. 9; 2001 a. 16; 2005 a. 74 ss. 111, 124 to 126; 2007 a. 39; 2013 a. 20.
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