Billing & Authorization

UPDATED:  Residential Claim Form and Revised General Services Claim Form
ATTENTION: “Fillable” Claim Form Templates
IMPORTANT: Where to Send Your Claims
Claims and Payment Timelines
Pharmacy Claims
Electronic Data Interchange
Service Authorizations
If Your Claim Has Been Partially or Completely Denied
If You Have Questions about Your Claims, Contact the Provider Help Desk

UPDATED:  Residential Claim Form and Revised General Services Claim Form

All Providers are asked to use a standard claim form (CMS 1500, UB04), one of Care Wisconsin’s two claim forms or a claim format approved by Care Wisconsin for submitting bills, invoices or claims.

We have updated our Residential Claim Form template and instructions with the new billing address.  We are also introducing a revised General Services Claim Form template and instructions (formerly the Non-Residential Claim Form) to use if you bill for non-residential services.  This claim form has been re-designed so that it can be quickly and smoothly scanned into the claims system.  Please use only the codes contained in your Authorization Letters, contract and/or individual member agreement if you are a residential facility.  Missing and/or non-standard codes will cause confusion and delays in payment.

ATTENTION: “Fillable” Claim Form Templates

Both claim forms are available in fillable formats so you can complete, download and print them for submission.  Also, we are now offering the claim form templates in the “excel” format.

 Residential Claim Form Template PDF – Fillable format
 Residential Claim Form Instructions

(***NOTE:  Please bill only residential services, such as “room & board” and “care & supervision” on the Residential Claim Form.  Use the General Services Claim Form for all non-residential services.)

 General Services Claim Form Template PDF – Fillable format
 General Services Claims Instructions  ***NEW ITEM

If you are interested in a fillable Excel version of either the Residential or General Services claim form, please contact the Provider Help Desk:

Provider Help Desk
(608) 245-3053
Toll-free 1-877-496-3858
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Monday through Friday, 8:30 a.m. to 4:00 p.m.

 Health Insurance Claim Form / CMS-1500

You will need Adobe Acrobat Reader to view and use the PDF Claim Forms. To download a free copy of Adobe Acrobat Reader, click here.

IMPORTANT: Where to Send Your Claims

After filling out the claim form, please print copies and then mail the completed claim to:

Care Wisconsin
PO Box 849
Buckeystown, MD 21717

Claims and Payment Timelines

Care Wisconsin will pay for services that are:  part of the provider’s contract, authorized by the care team, and provided to a member in the previous month or time period.  Regulations prevent Care Wisconsin from paying in advance for services.

Care Wisconsin will pay your claim within 30 days after receipt of a complete and accurate claim for an eligible member.  Claims payments, accompanied by an explanation voucher, are mailed twice a week on Wednesdays and Fridays.

Pharmacy Claims 

Contact PharmaStar at (715) 552-4320 or 1-888-298-7770 if you need information about drug claims.

Electronic Data Interchange

Another option for payment is EDI or Electronic Data Interchange through Emdeon Business Services.   For assistance with EDI, contact Emdeon Business Services Customer Solutions at (800) 845-6592.  You can also go to the Emdeon Business Services Website www.emdeon.com. 

 MCDS Submitters Customer Service Bulletin
 HCDS Submitters Customer Service Bulletin

Service Authorizations

Please be sure that the person for whom you are providing services under Family Care or Partnership is a Care Wisconsin member.  To access services, Partnership members use their Care Wisconsin Health Plan Member ID card and Family Care members use their Wisconsin Medicaid Forward ID Card. (Please note: There is not a separate member ID card for Family Care.) 

Prior authorization is required for services, and claims will not be paid without specific authorization.  Please contact a member's Care Wisconsin care team to receive prior authorization for services.

Submitting a CORRECTED claim for a claim that has been PARTIALLY denied:

• For a partially denied claim where the information submitted was incorrect, complete a new claim form with accurate information using the Care Wisconsin Residential Claim Form Instructions.  The new claim form must include ALL services billed on the original submission, not just those services that are being changed. 
• Indicate “Corrected Claim” in bold letters at the top of the form and include the claim number from the original claim, if possible.
• Staple a cover sheet on the Residential Claim Form stating “Attached is a corrected claim form for consideration.”  Each corrected claim form requires its own coversheet.
• Mail corrected form to: 

Care Wisconsin
P.O. Box 849
Buckeystown, MD  21717

Re-submitting a claim that has been COMPLETELY denied:

For a completely denied claim where the information submitted was incorrect, prepare the claim with the correct information on a new claim form and submit the claim form in the normal way.

If your claim was partially or completely denied for other than incorrect information:

First, please contact the Provider Help Desk if you need clarification on the denial.  If after checking with the help desk, you still believe that the denial or underpayment was in error, you may send a request for an appeal.  You must submit your appeal in writing within 60 calendar days of the denial by sending a letter marked “Appeal” with specific information to:   

Care Wisconsin
Attn:  Claims Appeals
P.O. Box 14017
Madison, WI 53708-0017   

If You Have Questions about Your Claims, Contact the Provider Help Desk

For questions related to reimbursement, payment, denials, adjustments, or refunds, contact the Care Wisconsin Provider Help Desk at (608) 245-3053 or toll-free 1-877-496-3858; Monday through Friday, 8:30 a.m. to 4:00 p.m. You can also send correspondence via U.S. mail or email.

Care Wisconsin Provider Help Desk
2802 International Lane
PO Box 14017
Madison, WI  53708-0017
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