August 18, 2022

Wisconsin Medicaid: Denial of claims with incorrect codes starting Sept. 19

Effective Sept. 19, 2022, we will deny claims containing incorrect revenue or incorrect procedure codes for the provider type billed. This policy aligns with the requirements set forth in the 21st Century Cures Act.

Per Wisconsin Medicaid Topic #4510-Procedure Codes/Revenue Codes: ForwardHealth requires outpatient hospital providers to indicate valid HCPCS or CPT® codes in addition to revenue codes on outpatient claims (13X). Certain revenue codes are exempt from this requirement.

When submitting claims for Medicaid patients, be sure to include the correct revenue and procedure codes. You can find a list of these codes on the ForwardHealth website.  

Questions?
For additional information, view provider-specific resources on ForwardHealth. 

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PCA-1-22-02437-BenOps-News