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December 14, 2023

Wisconsin Medicaid: Avoid claim denials for DME

We want to help you avoid denials when submitting durable medical equipment (DME) claims for UnitedHealthcare Community Plan members in Wisconsin.

To comply with Wisconsin Medicaid billing guidelines, effective Jan. 1, 2024, the number of days indicated on DME claims must equal the number of days within the dates of service (DOS) range. We will deny claims billed outside the calendar month.

Billing guidelines for rental and purchased DME claims

Rental

  • Rental DME must be ranged within the same calendar month per claim line
  • If the DOS range spans different months, this needs to be indicated separately on different claim lines
  • List “from” and “to” dates of service (DOS) on the claim
  • If the DME was provided on consecutive days, those dates may be indicated as a range of dates by entering the first date as the “from” DOS, and the last date as the “to” DOS

Please note the “to” DOS requirement does not apply to Medicare crossover claims.

Purchased

  • Indicate only 1 specific DOS for each purchase, not a range of dates
  • You can, however, list 2 consecutive dates, such as June 1, 2023, to June 2, 2023

Claim examples

Here are examples of claims billed with “from” and “to” DOS, with the unit number equaling the days billed:

 Jan. 1, 2023, to Jan. 31, 2023 = 31 units

Claim example DOS 31 units

 Jan. 24, 2023, to Jan. 31, 2023 = 8 units

Claim example DOS 8 units

For more information, see guidance from ForwardHealth

Questions? We're here to help.

Chat with us 7 a.m.–7 p.m. CT, Monday – Friday from the UnitedHealthcare Provider Portal. For additional contact information, visit our Contact us page.

PCA-1-23-03792-POE-NN_11272023

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