Wis. ForwardHealth Online Handbook, Hospice, Topic #22797

Providers are notified that an individual claim is subject to PIR (payment integrity review) through a message on the Portal when

submitting claims. When this occurs, providers have seven calendar days to submit the supporting documentation that must be

retained in the member's record for the specific service billed. This documentation must be attached to the claim. The following are

examples of documentation providers may attach to the claim; however, this list is not exhaustive, and providers may submit any

documentation available to substantiate payment:

• Case management or consultation notes

• Durable medical equipment or supply delivery receipts or proof of delivery and itemized invoices or bills

• Face-to-face encounter documentation

• Individualized plans of care and updates

• Initial or program assessments and questionnaires to indicate the start DOS (date of service)

• Office visit documentation

• Operative reports

• Prescriptions or test orders

• Session or service notice for each DOS

• Testing and lab results

• Transportation logs

• Treatment notes

Providers must attach this documentation to the claim at the time of, or up to seven days following, submission of the claim. A

claim may be denied if the supporting documentation is not submitted. If a claim is denied, providers may submit a new claim with

the required documentation for reconsideration. To reduce provider impact, claims reviewed by the OIG (Office of the Inspector

General) will be processed as quickly as possible, with an expected average adjudication of 30 days.