Wis. ForwardHealth Online Handbook, Hospice, Topic #4817

Providers may submit paper attachments to accompany electronic claims and electronic claim adjustments. Providers should refer

to their companion guides for directions on indicating that a paper attachment will be submitted by mail.

Paper attachments that go with electronic claim transactions must be submitted with the Claim Form Attachment Cover Page (F-

13470 (03/2023)). Providers are required to indicate an ACN (attachment control number) for paper attachment(s) submitted

with electronic claims. (The ACN is an alphanumeric entry between two and 80 digits assigned by the provider to identify the

attachment.) The ACN must be indicated on the cover page so that ForwardHealth can match the paper attachment(s) to the

correct electronic claim.

ForwardHealth will hold an electronic claim transaction or a paper attachment(s) for up to seven calendar days to find a match. If

a match cannot be made within seven days, the claim will be processed without the attachment and will be denied if an attachment

is required. When such a claim is denied, both the paper attachment(s) and the electronic claim will need to be resubmitted.

Providers are required to send paper attachments relating to electronic claim transactions to the following address:

ForwardHealth

Claims and Adjustments

313 Blettner Blvd

Madison WI 53784

This does not apply to compound and noncompound claims.