Request for Medicaid Coverage Consideration for Procedures and Devices (Dossier Process)

The Wisconsin Department of Health Services (DHS) ensures that policies are medically appropriate, patient-centered, transparent, and based on the best available evidence. The agency’s benefit policies outline the types of procedures and treatments for which Wisconsin Medicaid will pay for specific conditions. The ForwardHealth dossier provides a structured and uniform process for individuals to submit evidence related to the effectiveness and safety of a service to be reviewed for coverage.

How to submit proposals

To submit a proposal to cover a new product or service, please fill out our online request, F-02937.

If you have questions, updates, or concerns, please email us at DHSDMSDossiers@dhs.wisconsin.gov.

 

Proposal process and timeline

  • Each submission is reviewed and researched by a Medicaid policy analyst.
  • The review process includes conducting research on what other payers and various state Medicaid programs are covering, as well as analysis of the peer-reviewed literature and clinical guidelines for the submission.
  • This information is then presented for consideration to an internal governance committee comprised of Medicaid leadership. It can take DHS up to 120 days after the submission is received to complete the review.
  • If a submission moves forward, the policy development process can take six to 18 months depending on the topic.
  • Each submitter will receive a response after the governance committee meeting explaining the outcome of the committee's decision.

Please note: Wisconsin Medicaid will only consider coverage for services that have a permanent procedure code (CPT Level I or II) available for reimbursement. Emerging technologies, services, and procedures assigned temporary procedure codes (CPT level III) cannot be considered.

Last Revised: December 12, 2022