Prior Authorization in Wisconsin
Wisconsin requires PA decisions within specified timeframes and provides external review for denied claims. The state enacted step therapy override provisions allowing prescribers to request exceptions for clinical reasons. Wisconsin OCI oversees the external review process.
Key Facts About PA in Wisconsin
- ✓ Step therapy override provisions available for prescribers
- ✓ External review available through the WI Office of the Commissioner of Insurance
- ✓ PA decisions must be made within reasonable timeframes
- ✓ Multiple major carriers compete in the Wisconsin market
Quick Stats
- Typical Appeal Filing Window: 30 days
- External Review Available: Yes
- Major Payers: 4
Top Payers in Wisconsin
RxCheckUp generates payer-specific Letters of Medical Necessity for each of these Wisconsin carriers:
Anthem BCBS WisconsinUnitedHealthcareQuartzDean Health Plan