WI · guidance
Wis. ForwardHealth Online Handbook, Hospice, Topic #704
Claims That Fail to Cross Over
ForwardHealth must be able to identify the billing provider in order to report paid or denied Medicare crossover claims
information on the RA (Remittance Advice). Claims with an NPI (National Provider Identifier) that fails to appear on the
provider's RA are an indication that there is a problem with the matching and identification of the billing provider and the claims
were denied.
ForwardHealth is not able to identify the billing provider on automatic crossover claims submitted by health care providers in the
following situations:
• The billing provider's NPI has not been reported to ForwardHealth.
• The taxonomy code has not been reported to ForwardHealth or is not indicated on the automatic crossover claim.
• The billing provider's practice location ZIP+4 code on file with ForwardHealth is required to identify the provider and is not
indicated on the automatic crossover claim.
If automatic crossover claims do not appear on the ForwardHealth and/or the MCO's (managed care organization) RA after 30
days of the Medicare processing date, providers are required to resubmit the claim directly to ForwardHealth or the MCO using
the NPI that was reported to ForwardHealth as the primary NPI. Additionally, the taxonomy code and the ZIP+4 code of the
practice location on file with ForwardHealth are required when additional data is needed to identify the provider.
Provenance
- Source
- www.forwardhealth.wi.gov
- Retrieved
- 2026-10-02
- Edition
- forwardhealth-hospice-2026-10-01
- Content hash
a09633232b8227f2dad3850f571c22f17f3fec6f6c9b3eda5a84aa2a011a711c
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.