Medicare AdvantageAdministrativeHigh impact
Changes to Claims Processing for Members with Medicare Advantage and Medicare Cost Plans
Wisconsin Medicaid (ForwardHealth)·WI·Medical Policy
Effective date
Feb 9, 2018
We identified it
Jun 20, 2026
Summary
Effective February 9, 2018, ForwardHealth requires providers to bill Medicare Advantage and Medicare Cost plans directly before submitting claims to ForwardHealth for specific services including ambulance, hospital, physician, and other Medicare-covered services. Claims will be denied with specific EOB codes directing providers to bill the appropriate Medicare plan first.
Action Required
By February 9, 2018: Billing team must update workflow to bill Medicare Advantage and Medicare Cost plans BEFORE submitting claims to ForwardHealth for ambulance services, ambulatory surgery center services, chiropractic services, dental anesthesia services, home health services (excluding personal care), hospital services, Medicare-covered services, osteopath services, and physician services. Monitor for EOB codes #0771 (Medicare Advantage) and #3082 (Medicare Cost) which indicate claims must be resubmitted to the appropriate Medicare plan first. Out-of-network providers must refer members to in-network providers or cannot pursue payment from Medicaid or members for non-emergency services.