![]() If the primary insurance paid more than Medicaid allowable for the entire claim no additional money will be paid.Administratively, I think this makes sense, I am but slightly hesitant due to the challenges Social Security has had during the pandemic. My Choice Wisconsin Health Plan will consider the Medicaid allowable for the entire claim and the entire amount paid by the primary insurance when calculating secondary payment.Only services covered by Medicaid are payable regardless of other insurance coverage.My Choice Wisconsin Health Plan requires a copy of the EOB (Explanation of Benefits) or electronic submission of other insurance payments showing a denial or payment from the primary insurance carrier before payment will be considered or coordinated. My Choice Wisconsin Health Plan will deny claims if it is determined that the member has other insurance as their primary carrier. Providers must submit the documents within 120 days from the date on the primary RA.My Choice Wisconsin cannot accept secondary claims electronically. Following the primary insurance determination, paper copies of both the original claim form and the primary insurance Remittance Advice must be submitted to My Choice Wisconsin for secondary benefit determination (regardless of balance due).Providers must submit claims to the primary insurance before submitting to My Choice Wisconsin.If your claim has not been processed within 60 days of the Medicare Remittance Advice, please submit your claim to My Choice Wisconsin, with a paper copy of the Medicare Remittance Advice, to the appropriate TPA, address listed above.If your Medicare Remittance Advice indicates that the claim was forwarded to My Choice Wisconsin, you should not submit a claim to My Choice Wisconsin.In many cases where traditional Medicare is the primary carrier, Medicare will automatically forward claims to My Choice Wisconsin.If traditional Medicare is the primary carrier: The Provider Handbook has more details on coordination of benefits. If a member carries other insurance through more than one insurer, My Choice Wisconsin will coordinate the benefits to ensure maximum coverage without duplication of payments. If you disagree with our appeal decision for BadgerCare Plus members, you may submit a second level appeal to the State of Wisconsin at:īadgerCare Plus and Medicaid SSI Managed Care Unit – Provider Appealįamily Care, Partnership, SSI, and Dual Advantage Members ![]() Medical and Behavioral Health Claims Appealsįor Dental and Vision Claims see the BadgerCare Quick Reference Contact Sheet. See the BadgerCare Plus Provider Handbook for more information. If you still believe a denial was in error or there are extenuating circumstances you would like us to consider, you may send an appeal to My Choice Wisconsin BadgerCare Plus using our Appeal Form. Claims which are denied or paid incorrectly due to an error on the provider’s end should be resubmitted as a Corrected Claim and mailed to: If a claim is denied, you will receive an explanation of benefits with a reason code and explanation of that code. Family Care and Partnership waiver service providers who are unable to submit using one of the standard claims forms mentioned above are encouraged to submit using one of our alternative methods described below.Ĭognizant (TriZetto) Claims Portal BadgerCare Plus commonly referenced documents Please use the standard CMS-1500 or UB-04 claims form (or electronic 837P or 837I) when billing My Choice Wisconsin for Medicare and Medicaid services. WPS Electronic Funds Transfer (EFT) Tip Sheet.Cognizant (Trizetto) Electronic Funds Transfer (EFT) Authorization Form.Family Care, Partnership, SSI, and Dual Advantage commonly referenced documents Providers can find more information in this October 2020 memo and on our Provider Q&A page. For other important information about programs, authorizations, and much more search our full Provider Resource Library you may use the search feature to find a specific document or use the “Document Types” filter to limit to category-specific documents.Īs of November 2, 2020, the Wisconsin Department of Health Services begins implementing electronic visit verification for Medicaid-covered personal care services. All claims-related forms are in the resource library below. Claims processes, timelines, forms, and resources can be found here.
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