MedicaidAdministrativeHigh impact
New Requirements for Paper Claims and Paper Claim Adjustments with Other Health Insurance Indicated
Wisconsin Medicaid (ForwardHealth)·WI·Billing
Effective date
Nov 12, 2014
We identified it
Jun 20, 2026
Summary
Wisconsin ForwardHealth now requires a new Explanation of Medical Benefits form (F-01234) for all paper claims and adjustments when other health insurance is indicated. Paper claims without this form will be returned unprocessed.
Action Required
By November 12, 2014: Billing team must obtain the new Explanation of Medical Benefits form F-01234 (11/14) from ForwardHealth Portal and include one form for each other payer indicated on paper claims and adjustments for Wisconsin Medicaid, BadgerCare Plus, and Wisconsin Chronic Disease Program. Update paper claim submission workflows to include this mandatory form. Stop using 1500 Health Insurance Claim Form version 08/05 and switch to version 02/12. Claims submitted without the correct form will be returned unprocessed.