MedicaidAdministrativeMedium impact
ForwardHealth Is Postponing the Explanation of Medical Benefits Form Requirement for Paper Claims and Paper Claim Adjustments with Other Health Insurance Indicated
Wisconsin Medicaid (ForwardHealth)·WI·Billing
Effective date
Dec 10, 2014
We identified it
Jun 20, 2026
Summary
ForwardHealth is postponing the requirement to submit Explanation of Medical Benefits forms (F-01234) with paper claims and adjustments that have other health insurance. Providers should revert to indicating other insurance information directly on 1500 and UB-04 forms instead of using the separate EOB form.
Action Required
Effective December 10, 2014: Stop submitting Explanation of Medical Benefits forms (F-01234) with paper 1500 and UB-04 claims. Billing team must revert to indicating other insurance information directly on claim forms using OI codes (OI-P, OI-D, OI-Y) in Item 9 of 1500 forms. Update paper claim workflows to remove EOB form attachment requirements for ForwardHealth submissions.