Authorization & Billing

 
NEW FOR PROVIDERS:  “Fillable” invoice templates that you can now complete by typing your information right on the form. 

•  Residential Invoice Template - Effective August 1, 2010 and  Instructions
  
  Please use this Residential Invoice Template for July 2010 dates of service and after.

•  Residential Invoice Template - Discontinue July 31, 2010  and  Instructions
  
  Please stop use of this Residential Invoice Template after the June 2010 dates of service.
   
•  Non-Residential Invoice Template

After filling out the invoice, please print copies and then mail the completed invoice to our third party administrator: 

TriZetto - Care Wisconsin
P.O. Box 853924
Richardson, TX  75085-3924

You will need Adobe Acrobat Reader to view and use the template invoice forms.  To download a free copy of Adobe Acrobat Reader, click here. 

How to Bill?

For questions about delayed claims payments, click here.

TriZetto, Inc, a third party administrator (TPA) receives and processes your claims (bills/invoices) for services provided to members in our Family Care and Family Care Partnership programs.  Please submit drug claims to PharmaStar.

• Use your Provider ID#.
• Mail your claims directly to TriZetto. 

TriZetto - Care Wisconsin
P.O. Box 853924
Richardson, TX  75085-3924

All Providers are asked to use a standard claim form (CMS 1500, UB04) or a template approved by Care Wisconsin for submitting bills, invoices or claims.  All bills, invoices and claims must have the correct procedure or revenue codes indicated.  If you are not using such a form or are not properly coding your claims, call our Provider Help Desk to see if you need to change your billing format.  Failure to do so may cause payment delays.

Our intention is to pay your invoice or claim within 30 days after receiving a complete and accurate claim for an eligible member. Payment will be mailed to you. Therefore you will not be able to pick up payment at a local office. Payment will be for all charges related to authorized services you provided to a member in the previous month.

If payment is denied (in full or in part), you may file an appeal within 60 calendar days of receipt of our initial denial by sending a letter to us explaining why payment should be made.

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Health Insurance Claim Form:

 Health Insurance Claim Form/CMS-1500

Pharmacy Claims

Contact PharmaStar at (715) 552-4320 or 1-888-298-7770

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

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. 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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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.)

For sample Partnership member ID cards, click here.

Prior authorization is required under Family Care. Please contact a member's Care Wisconsin care team to receive prior authorization for services.