Wis. ForwardHealth Online Handbook, Hospice, Topic #532

When correcting an overpayment through an adjustment request, providers may submit the adjustment request electronically or on

paper. Providers should not submit provider-based billing claims through adjustment processing channels.

ForwardHealth processes an adjustment request if the provider is all of the following:

• Medicaid-enrolled on the DOS (date of service).

• Not currently under investigation for Medicaid fraud or abuse.

• Not subject to any intermediate sanctions under Wis. Admin. Code § DHS 106.08.

• Claiming and receiving ForwardHealth reimbursement in sufficient amounts to allow the recovery of the overpayment within

a very limited period of time. The period of time is usually no more than 60 days.

Electronic Adjustment Requests

Wisconsin Medicaid will deduct the overpayment when the electronic adjustment request is processed. Providers should use the

companion guide for the appropriate 837 (837 Health Care Claim) transaction when submitting adjustment requests.

Paper Adjustment Requests

For paper adjustment requests, providers are required to do the following:

• Submit an Adjustment/Reconsideration Request (F-13046 (02/2025)) form through normal processing channels (not timely

filing), regardless of the DOS

• Indicate the reason for the overpayment, such as a duplicate reimbursement or an error in the quantity indicated on the

claim

After the paper adjustment request is processed, Wisconsin Medicaid will deduct the overpayment from future reimbursement

amounts.