MedicaidAdministrativeMedium impact
Introducing the Wisconsin Medicaid Claim Refund form and instructions
Wisconsin Medicaid (ForwardHealth)·WI·Billing
Effective date
Oct 1, 2003
We identified it
Jun 20, 2026
Summary
Wisconsin Medicaid is introducing a new voluntary Claim Refund form (HCF 13066) that providers can use when returning cash refunds to Wisconsin Medicaid, effective October 1, 2003. Providers can choose to use this new form or continue using existing refund procedures with the paper Remittance and Status Report.
Action Required
By October 1, 2003: Wisconsin Medicaid providers should obtain copies of the new Claim Refund form (HCF 13066) from the Wisconsin Medicaid website or by calling Provider Services at (800) 947-9627. Train billing staff on proper completion of the form including all required elements (provider numbers, recipient information, procedure codes, refund reasons). Update refund procedures to mail completed forms with refund checks to Wisconsin Medicaid Financial Services Cash Unit at 6406 Bridge Rd, Madison WI 53784-0004. Note that use of this form is voluntary - existing refund procedures remain valid.