Wis. ForwardHealth Online Handbook, Hospice, Topic #205

Requests for billing or medical claim information regarding services reimbursed by Wisconsin Medicaid may come from a variety

of individuals including attorneys, insurance adjusters, and members. Providers are required to notify ForwardHealth when

releasing billing information or medical claim records relating to charges for covered services except in the following instances:

• When the member is a dual eligible (for example, member is eligible for both Medicare and Wisconsin Medicaid or

BadgerCare Plus) and is requesting materials pursuant to Medicare regulations.

• When the provider is attempting to exhaust all existing health insurance sources prior to submitting claims to

ForwardHealth.

Request From a Member or Authorized Person

If the request for a member's billing information or medical claim records is from a member or authorized person acting on behalf

of a member, the provider is required to do the following:

1. Send a copy of the requested billing information or medical claim records to the requestor.

2. Send a letter containing the following information to ForwardHealth:

• Member's name

• Member's ForwardHealth identification number or SSN (Social Security number), if available

• Member's DOB (date of birth)

• DOS (date of service)

• Entity requesting the records, including name, address, and telephone number

The letter must be sent to the following address:

Wisconsin Casualty Recovery— HMS

Ste 100

5615 Highpoint Dr

Irving TX 75038-9984

Request From an Attorney, Insurance Company, or Power of Attorney

If the request for a member's billing information or medical claim records is from an attorney, insurance company, or power of

attorney, the provider is required to do the following:

1. Obtain a release signed by the member or authorized representative.

2. Furnish the requested material to the requester, marked BILLED TO FORWARDHEALTH or TO BE BILLED TO

FORWARDHEALTH, with a copy of the release signed by the member or authorized representative. Approval from

ForwardHealth is not necessary.

3. Send a copy of the material furnished to the requestor, along with a copy of their original request and medical authorization

release to:

Wisconsin Casualty Recovery— HMS

Ste 100

5615 Highpoint Dr

Irving TX 75038-9984

Request for Information About a Member Enrolled in a State-Contracted

Managed Care Organization

If the request for a member's billing information or medical claim records is for a member enrolled in a state-contracted MCO

(managed care organization), the provider is required to do the following:

1. Obtain a release signed by the member or authorized representative.

2. Send a copy of the letter requesting the information, along with the release signed by the member or authorized

representative, directly to the MCO.

The MCO makes most benefit payments and is entitled to any recovery that may be available.

Request for a Statement From a Dual Eligible

If the request is for an itemized statement from a dual eligible, pursuant to HR 2015 (Balanced Budget Act of 1997) § 4311, a

dual eligible has the right to request and receive an itemized statement from their Medicare-enrolled health care provider. The Act

requires the provider to furnish the requested information to the member. The Act does not require the provider to notify

ForwardHealth.