MedicaidAdministrativeHigh impact
ForwardHealth Is Reinstating the Explanation of Medical Benefits Form Requirements for Paper Claims and Paper Claim Adjustments with Other Health Insurance Indicated
Wisconsin Medicaid (ForwardHealth)·WI·Billing
Effective date
Aug 3, 2015
We identified it
Jun 20, 2026
Summary
ForwardHealth is reinstating the requirement for providers to include the Explanation of Medical Benefits form (F-01234) with all paper claims and paper claim adjustments when other health insurance is indicated. This applies to Wisconsin Medicaid, BadgerCare Plus, and related programs as secondary payers.
Action Required
By August 3, 2015: Billing team must include the exact ForwardHealth Explanation of Medical Benefits form (F-01234) with ALL paper claims and paper claim adjustments when other health insurance is indicated. Download the exact form from ForwardHealth Portal - no alternate versions accepted. Update workflow for 1500 and UB-04 forms to remove payment amounts and OI indicators from the claim forms and include them on the EOB form instead. Claims without the required EOB form will be returned unprocessed or denied.