WI · guidance
Wis. ForwardHealth Online Handbook, Hospice, Topic #16937
Electronic Claims and Claim Adjustments With Other Commercial Health
Insurance Information
Effective for claims and claim adjustments submitted electronically via the Portal or PES software on and after June 16, 2014,
other insurance information must be submitted at the detail level on professional, institutional, and dental claims and adjustments if
it was processed at the detail level by the primary insurance. Except for a few instances, Wisconsin Medicaid or BadgerCare Plus
is the payer of last resort for any covered services; therefore, providers are required to make a reasonable effort to exhaust all
existing other health insurance sources before submitting claims to ForwardHealth or to a state-contracted MCO (managed care
organization).
Other insurance information that is submitted at the detail level via the Portal or PES software will be processed at the detail level
by ForwardHealth.
Under HIPAA (Health Insurance Portability and Accountability Act of 1996), claims and adjustments submitted using an 837
transaction must include detail-level information for other insurance if they were processed at the detail level by the primary
insurance.
Adjustments to Claims Submitted Prior to June 16, 2014
Providers who submit professional, institutional, or dental claim adjustments electronically on and after June 16, 2014, for claims
originally submitted prior to June 16, 2014, are required to submit other insurance information at the detail level on the adjustment
if it was processed at the detail level by the primary insurance.
Provenance
- Source
- www.forwardhealth.wi.gov
- Retrieved
- 2026-10-02
- Edition
- forwardhealth-hospice-2026-10-01
- Content hash
5734fb5e75fab18cf9654f48dbf2b287f54f3d109f49552c32fe0ad7eeadf4ba
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