Wis. ForwardHealth Online Handbook, Hospice, Topic #10637

As a result of the Medicaid Rate Reform project, ForwardHealth will reduce reimbursement on most claims submitted to

ForwardHealth on paper. Most paper claims will be subject up to a $1.10 reimbursement reduction per claim.

For each claim that a reimbursement reduction was applied, providers will receive an EOB (Explanation of Benefits) to notify

them of the payment reduction. For claims with reimbursement reductions, the EOB will state the following, "This claim is eligible

for electronic submission. Up to a $1.10 reduction has been applied to this claim payment."

If a paid claim's total reimbursement amount is less than $1.10, ForwardHealth will reduce the payment up to a $1.10. The claim

will show on the RA (Remittance Advice) as paid but with a $0 paid amount.

The reimbursement reduction applies to the following paper claims:

• 1500 Health Insurance Claim Form ((02/12))

• UB-04 (CMS 1450) Claim Form

• Compound Drug Claim (F-13073 (04/2017)) form

• Noncompound Drug Claim (F-13072 (02/2025)) form

Exceptions to Paper Claim Reimbursement Reduction

The reimbursement reduction will not affect the following providers or claims:

• In-state emergency providers

• Out-of-state providers

• Medicare crossover claims

• Any claims that ForwardHealth requires additional supporting information to be submitted on paper, such as:

» Hysterectomy claims must be submitted along with an Acknowledgment of Receipt of Hysterectomy Information (F-

01160 (06/2013)) form.

» Sterilization claims must be submitted along with a paper Consent for Sterilization (DMS-1000 (05/2025)) form.

» Claims submitted to Timely Filing appeals must be submitted on paper with a Timely Filing Appeals Request (F-

13047 (08/2015)) form.

» In certain circumstances, drug claims must be submitted on paper with a Pharmacy Special Handling Request (F-

13074 (04/2014)) form.

» Claims submitted with four or more NDCs (National Drug Codes) for compound and noncompound drugs with

specific and non-specific HCPCS (Healthcare Common Procedure Coding System) procedure codes.