Traditional MedicareAdministrativeHigh impact
Changes to billing and reimbursement for services provided to dual entitlees as a result of HIPAA and the Wisconsin biennial budget
Wisconsin Medicaid (ForwardHealth)·WI·Billing
Effective date
Oct 13, 2003
We identified it
Jun 20, 2026
Summary
Wisconsin Medicaid updated billing requirements for dual-eligible patients due to HIPAA compliance and state budget changes. Providers must include specific Medicaid identification information in Medicare crossover claims to ensure proper reimbursement, and Wisconsin Medicaid will now pay Medicare HMO copayments.
Action Required
Immediately: Billing team must update electronic claim submission processes to include Medicaid provider number in the billing provider secondary identification segment on 837I and 837P transactions. Include recipient's Medicaid ID number and rendering provider number in the other subscriber information loop. For Medicare HMO claims, submit crossover claims directly to Wisconsin Medicaid after receiving Medicare payment notification. Failure to include required information may result in claim denials, incorrect reimbursement, or claims not automatically crossing over.