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Claims Information

Claims Forms

All Providers are asked to use the standard CMS-1500 or UB-04 claims form (or electronic 837P or 837I) when billing Care Wisconsin. Family Care and Partnership providers who are unable to submit using one of the standard claims forms mentioned above must use the Care Wisconsin claims forms below, or a claim form approved by Care Wisconsin for submitting bills, invoices or claims.

PDF document Residential Claim Form Template PDF — Fillable format (253 KB)

Note: The Residential Claim Form has been updated as of 2/5/16. Claims will not deny if submitted on old forms during the transition, but  we expect providers to use new forms by 3/31/16. If you have questions, please call the Provider Help Desk at 1-855-878-6699.  

PDF document Residential Claim Form Instructions (123 KB)

(***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.)

PDF document General Services Claim Form Template PDF — Fillable format (241 KB)
Please Note: The General Services Claim Form has been updated as of 2/5/2016. Claims will not deny  if submitted on old forms during the transition, but we expect providers to use new forms by 3/31/16. If you have questions, please call the Provider Help Desk at 1-855-878-6699.

PDF document General Services Claims Instructions (105 KB)

Care Wisconsin Provider Help Desk

Toll-free: 1-855-878-6699
Hours: Monday through Friday,  8 am. to 11:30 a.m. and noon to 4 p.m.

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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 226897
Dallas, TX 75222-6897

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Claims Web Portal

Access the Claims Web Portal.

The Claims Web Portal is only for providers who currently bill on the Care Wisconsin Claim Forms, General or Residential. If you are one of these providers, you have the option to bill electronic using the Claims Web Portal. You can view electronic remittance, verify eligibility, and check claim status through the Claims Web Portal. There are also helpful links to the Provider News, Provider Manuals and the Provider Directory.

To sign up, please follow the step-by-step instructions in the PDF document Claims Web Portal User Guide.

If you are unsure if your services are applicable or have any questions, please contact the This email address is being protected from spambots. You need JavaScript enabled to view it..

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Claims and Payment Timelines

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 or deposited twice a week on Wednesdays and Fridays, excluding holidays.

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.

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Direct Deposit

To enroll in Direct Deposit/Electronic Funds Transfer (EFT), please complete and send back the form below, along with a voided check, via fax or email.

PDF document Electronic Funds Transfer (EFT) Authorization Form (119KB)

Please note: By enrolling with EFT you are opting out of receiving paper remits/EOBs:

  • If you submit your claims via paper, spreadsheet, or electronically through the Claims Web Portal, your provider remittance advice will only be available on the Claims Web Portal. Review this document for information about PDF document How to obtain a copy of your Explanation of Benefits (107KB).
  • If you submit claims electronically via 837P or 837I, you may obtain your provider remittance advice electronically through the HIPAA 835 transaction.

This is a free service that you can start or end at any time.

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Pharmacy Claims

Contact Care Wisconsin at 1-800-963-0035 if you need information about drug claims for Partnership or Medicare Dual Advantage. For SSI, the pharmacy benefit is administered by ForwardHealth.

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Electronic Data Interchange

 Another option for claim submission is EDI or Electronic Data Interchange through Change Healthcare, formerly Emdeon Business Services, using a Payer ID of 27004 for Care Wisconsin. For assistance with EDI, contact Change Healthcare directly at (800) 845-6592. You can also go to the Change Healthcare Website at www.changehealthcare.com.

 

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If Your Claim Has Been Partially or Completely Denied

Submitting a CORRECTED CLAIM for a PARTIALLY DENIED CLAIM where the information submitted was incorrect:

  • Complete a new claim form with accurate information using the appropriate claim form and 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 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
    PO Box 226897
    Dallas, TX 75222-6897

Re-submitting COMPLETELY DENIED CLAIM where the information 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
    1617 Sherman Ave.
    Madison, WI 53708-0017

To expedite your appeal, please use the Provider Appeals form.

PDF document Provider Appeals Form (195 KB)

If Your Claim has been Overpaid

When refunding an overpayment, please cut a check made payable to "Care Wisconsin" and complete the Provider Refund Form.

PDF document Provider Refund Form (179 KB)

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

For questions related to reimbursement, payment, denials, adjustments, or refunds, This email address is being protected from spambots. You need JavaScript enabled to view it..

Care Wisconsin Provider Help Desk
Toll-free: 1-855-878-6699
Hours: Monday through Friday, 8 a.m. to 11:30 a.m. and noon to 4 p.m.

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Coordination of Benefits Information

Coordination of benefits is the process used to determine whether Care Wisconsin is the primary or secondary payer on claims submitted on behalf of Care Wisconsin members. For more information on coordination of benefits for Care Wisconsin members, please reference the program specific Provider Manual.

PDF document Access the Provider Manual for Partnership and Family Care Programs (see 10-2).

PDF document Access the Provider Manual for Medicaid SSI (see page 33).

pdf Access the Provider Manual for Medicare Dual Advantage (see page 32).

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