Medicare AdvantageAdministrativeMedium impact
Recipients with Medicare Managed Care Coverage
Wisconsin Medicaid (ForwardHealth)·WI·Medical Policy
Effective date
Aug 1, 2004
We identified it
Jun 20, 2026
Summary
Wisconsin providers must now submit claims directly to Wisconsin Medicaid for dual eligible patients enrolled in Medicare Managed Care (MMC) because claims no longer automatically crossover from MMC carriers. Electronic claims must include copayment/coinsurance/deductible amounts, while paper claims should be marked 'MMC' and include carrier determination documentation.
Action Required
Immediately for Wisconsin providers: Update billing workflows to submit all dual eligible MMC patient claims directly to Wisconsin Medicaid instead of relying on automatic crossover. For electronic claims using PES software, ensure copayment/coinsurance/deductible amounts are entered. For paper claims, write 'MMC' in upper right corner and attach MMC carrier's remittance advice or EOB. Verify patient MMC coverage using Medicaid Eligibility Verification System (EVS) before billing.