Provider Network - HIRSP Federal Plans

HIRSP Federal Plan In-State

If you receive health care services described in this section from a health care provider in Wisconsin, that health care provider must be a Wisconsin Medicaid-certified health care provider. HIRSP will pay benefits up to the HIRSP allowed amount. You are responsible for any applicable deductible and coinsurance amounts.

HIRSP Federal Plan Out-of-State

If you receive health care services described in this section from a health care provider outside of Wisconsin who is not Wisconsin Medicaid-certified, HIRSP will pay benefits for those health care services up to the HIRSP allowed amount. You are responsible for any amounts billed over the HIRSP allowed amount. The billed amount you are responsible for may be as much as, if not more than, 40% of the provider’s charge for those health care services. Also, you are responsible for any applicable deductible and coinsurance amounts.

HIRSP members MAY be BALANCE BILLED* by out-of-state providers if they refuse to accept HIRSP payment rates as payment in full for the services provided.

*Balance Billed: Occurs when a provider bills a Member for some or all of the remaining charges not paid for by HIRSP, which may include those charges that are above what HIRSP would typically pay for a service or item.

HIRSP Federal Certified Providers

To find a HIRSP Federal certified provider or verify your provider is HIRSP Federal certified call:

1-888-253-2698