WI · guidance
Wis. ForwardHealth Online Handbook, Hospice, Topic #516
Accuracy of Claims
The provider is responsible for the accuracy and completeness of all claims submitted either by the provider or by an outside
billing service or clearinghouse.
ForwardHealth requires that all codes indicated on claims and PA (prior authorization) requests be valid, including:
• Diagnosis codes
• Revenue codes
• HCPCS (Healthcare Common Procedure Coding System) codes
• HIPPS (Health Insurance Prospective Payment System) codes
• CPT (Current Procedural Terminology) codes
Providers should refer to current national coding and billing manuals for information on valid code sets. ForwardHealth will:
• Deny claims received without valid diagnosis codes, revenue codes, and HCPCS, HIPPS, or CPT codes.
• For pharmacy providers, return PA requests received without valid codes to the provider.
Providers may submit claims only after the service is provided.
A provider may not seek reimbursement from ForwardHealth or a state-contracted HMO for a noncovered service by charging
ForwardHealth for a covered service that was not actually provided to the member and then applying the reimbursement toward
the noncovered service. In addition, a provider may not seek reimbursement for two separate covered services to receive
additional reimbursement over the maximum allowed amount for the one service that was provided. Such actions are considered
fraudulent.
Provenance
- Source
- www.forwardhealth.wi.gov
- Retrieved
- 2026-10-02
- Edition
- forwardhealth-hospice-2026-10-01
- Content hash
a59047afdc0f652d2207b012386e82c07c5a280ded492e78049919225871409f
The link goes to the issuing authority’s own document — the one we read to produce this record. Where a source publishes whole titles rather than sections, your browser may need a moment to jump to the provision.
Unofficial copy of government-published law, reproduced from official sources with full provenance. Not an official publication; verify against official sources before relying on it in a filing. Records in the 'guidance' corpus, and only that corpus, are sub-regulatory (interpretive guidelines, survey procedures) and are not binding law. Validity bounds follow each jurisdiction's declared temporalBasis.