State · WI
Medical billing services in Wisconsin
Short answer
Medical billing services in Wisconsin run through ForwardHealth, the DHS umbrella for Wisconsin Medicaid and BadgerCare Plus: fee-for-service claims go through the ForwardHealth Portal, and most BadgerCare Plus members are in one of 13 HMOs, assigned by the state when they do not choose. CMS counted 67 percent of Wisconsin Medicaid enrollees in full-benefit managed care in 2024.
CLTS waiver claims follow a 365-day filing period aligned with Wisconsin Medicaid, a fee-for-service home care claim without a matching EVV visit denies with EOB 1047, and MTM schedules rides with two full business days of notice. A Remitwright dedicated biller works those rules, serving Wisconsin practices remotely. Rules for other states are on the medical billing services by state page.
Last reviewed by the Remitwright billing team. Editorial policy
Billing in Wisconsin: what's different
The rules below change how a claim is filed and paid in Wisconsin. Each line links to the official page it was read from, and the date at the top of this page is when it was last checked.
| Fact | In Wisconsin | Source |
|---|---|---|
| Medicaid program | Wisconsin Medicaid and BadgerCare Plus (ForwardHealth)Wisconsin Department of Health Services (DHS) | 1 |
| Fee-for-service portal | ForwardHealth Portal | 1 |
| How Medicaid is delivered | Mostly HMOs | 2 |
| Managed care plans | 13 plansAnthem Blue Cross and Blue Shield, Chorus Community Health Plans, Dean Health Plan, Group Health Cooperative of Eau Claire, Group Health Cooperative of South Central Wisconsin, Independent Care Health Plan (iCare), MercyCare Insurance Company, MHS Health Wisconsin, Molina Health Care, Network Health Plan, Quartz, Security Health Plan of Wisconsin, UnitedHealthcare of Wisconsin | 3 |
| Medicaid timely filing (CLTS waiver claims, per DHS) | 365 calendar days from the date of service | 5 |
| Prompt-pay law | Wis. Stat. § 628.46 | 6 |
| NEMT | Single statewide manager | 8 |
| EVV | Open vendor model | 9 |
Wisconsin Medicaid and BadgerCare Plus (ForwardHealth)
Wisconsin Medicaid and BadgerCare Plus (ForwardHealth) is run by the Wisconsin Department of Health Services (DHS). Fee-for-service claims and provider enrollment go through the ForwardHealth Portal1, at www.forwardhealth.wi.gov. Mostly HMOs: CMS counted 896,539 of Wisconsin's 1,339,124 Medicaid enrollees, 67.0 percent, in full-benefit managed care in 20242. Counting every kind of managed care arrangement, not only full-benefit plans, the same CMS data puts 952,642 enrollees, 71.1 percent, in some form of managed care.
Medicaid timely filing (CLTS waiver claims, per DHS): 365 calendar days from the date of service, the period DHS set for Children's Long-Term Support waiver claims from July 1, 2021 to align them with Wisconsin Medicaid's timely claim processing policies5. DHS made the change to comply with the federal timely claim payment rule in 42 CFR 447.45. For CLTS waiver claims, WPS, the state's third-party administrator, edits timeliness on the date of service billed and the WPS received date, and when Medicare or private insurance pays first, WPS processes the CLTS claim within 365 days of that payer's explanation of benefits. Managed care plans set their own limits in their provider manuals, so the deadline on a Wisconsin Medicaid claim depends on which plan holds the member on the date of service.
Managed care plans3
- Anthem Blue Cross and Blue ShieldBadgerCare Plus and Medicaid SSI
- Chorus Community Health PlansBadgerCare Plus
- Dean Health PlanBadgerCare Plus
- Group Health Cooperative of Eau ClaireBadgerCare Plus and Medicaid SSI
- Group Health Cooperative of South Central WisconsinBadgerCare Plus
- Independent Care Health Plan (iCare)BadgerCare Plus and Medicaid SSI
- MercyCare Insurance CompanyBadgerCare Plus
- MHS Health WisconsinBadgerCare Plus and Medicaid SSI
- Molina Health CareBadgerCare Plus and Medicaid SSI
- Network Health PlanBadgerCare Plus and Medicaid SSI
- QuartzBadgerCare Plus and Medicaid SSI
- Security Health Plan of WisconsinBadgerCare Plus and Medicaid SSI
- UnitedHealthcare of WisconsinBadgerCare Plus and Medicaid SSI
Each plan is credentialed separately, has its own portal and its own appeal route. A practice that joins Wisconsin Medicaid through one plan is not in network with the others until each contract is in place.
Commercial payers and the prompt-pay law
Commercial payers active in Wisconsin7: Compcare (doing business as Anthem Blue Cross and Blue Shield), Security Health Plan of Wisconsin, Dean Health Plan by Medica, Medica Community Health Plan, Aspirus Health Plan, HealthPartners Insurance Company, UnitedHealthcare of Wisconsin, Quartz Health Benefit Plans Corporation. Filing windows, corrected-claim processes and appeal levels differ from one to the next, and each payer sets them out in its own provider manual; the timely filing limits table gathers verified payer deadlines with their sources.
Clean-claim payment window under Wis. Stat. § 628.46: 30 days after the insurer is furnished written notice of the fact of a covered loss and of the amount of the loss, after which the claim is overdue6. The Commissioner of Insurance quoted that sentence of the statute in an October 7, 2025 bulletin to property and casualty insurers about flood claims, alongside Wis. Adm. Code Ins 6.11, which requires insurers to affirm or deny coverage within a reasonable time after proof of loss has been completed. For health claims, the payer contract adds its own clean claim terms and appeal steps. That window sets the pace of A/R follow-up. Once a clean claim passes it, the claim is escalated to the payer with the statute cited, and interest is requested where the law provides for it.
NEMT and home care in Wisconsin
Non-emergency medical transportation. Single statewide manager: MTM schedules nonemergency medical transportation for BadgerCare Plus (including Express Enrollment), Wisconsin Medicaid, Family Planning Only Services and Tuberculosis-Related Only Services members through the MTM Link portal and its phone line8. Online scheduling needs at least two full business days before the appointment; first-time riders and new appointment locations book by phone. A member who drives to an appointment and cannot afford fuel can be reimbursed 24 cents a mile. The NEMT billing in Wisconsin page covers trip documentation, broker claims and reconciliation.
Electronic visit verification. Open vendor model: a provider uses the DHS-provided Sandata system or an alternate EVV system that meets the technical requirements and sends visits to the Sandata Aggregator9. Personal care and supportive home care codes S5125, S5126, T1019 and T1020 hard launched on May 1, 2023; home health codes 92507, 97139, 97799, 99504, 99600, S9123, S9124, T1001, T1021 and T1502, plus 99509, hard launched on October 1, 2024. A fee-for-service claim with no EVV record for the date of service denies on the remittance advice with EOB 1047, "EVV System Visit not found". See home care billing in Wisconsin for waiver programs, EVV exceptions and authorizations.
Rules that change how Wisconsin claims are billed
A fee-for-service home care claim with no EVV visit denies with EOB 104710
DHS's EVV questions page spells out the mechanics: a fee-for-service provider gets the denial on the remittance advice with an explanation of benefits message, and EOB 1047, "EVV System Visit not found", means ForwardHealth found no EVV information for the date of service billed. Claim submission requirements did not change with EVV, so the fix is in the visit record, not the claim form, and providers can read every EOB code on a ForwardHealth claim in the Portal. HMO providers take billing and EVV claim questions to the HMO, and live-in workers can be required to use EVV by an HMO, a managed care organization or the agency itself.
BadgerCare Plus members who do not pick an HMO are assigned one4
Most people who get BadgerCare Plus get it through HMOs, and DHS picks a plan for any member who does not choose one by the due date on the enrollment letter. Thirteen HMOs hold BadgerCare Plus contracts, each covering its own set of counties, and nine of them also serve Medicaid SSI members, who are likewise assigned if they do not choose by the deadline. A new patient's HMO has to be confirmed at every visit, because the plan on file may have been assigned rather than selected and can change at the next enrollment window.
Late claims go to ForwardHealth Timely Filing on form F-13047, for seven reasons only12
A claim or adjustment past the deadline is sent on paper to ForwardHealth Timely Filing with the Timely Filing Appeals Request, F-13047, one form per claim, and ForwardHealth accepts only an exact copy of the form. The reasons it considers for late processing are a denial for an enrollment-related EOB, reason, remark or NCPDP reject code, a nursing home level of care or liability amount change, retroactive member enrollment, a primary payer reconsideration, a ForwardHealth reconsideration, a fair hearing decision and a court order, with the Explanation of Medical Benefits form, F-01234, attached where it applies.
MTM rides need two business days of notice, and first trips are booked by phone8
DHS's nonemergency transportation manager, MTM, lets members schedule online through the MTM Link portal only when the ride is at least two full business days away and the destination is already on file; first-time users and new appointment locations have to call MTM. Members who drive themselves and cannot afford fuel can claim 24 cents a mile. For a clinic that schedules Medicaid patients, that two-day rule decides whether a same-week appointment has a ride attached.
Twelve marketplace insurers for 2027, and no one leaving the state11
The Office of the Commissioner of Insurance's October 30, 2026 open enrollment preview reports twelve insurers participating on Wisconsin's marketplace for the 2027 plan year, two more selling ACA-compliant plans off the marketplace, no insurer leaving the market and a weighted average individual market rate increase of 21.7 percent. OCI's county map of individual market insurers, updated October 22, 2026, lists which carriers sell in each county, which is the quickest way to predict the payer mix of a practice's self-pay and marketplace patients.
Services for Wisconsin practices
Remitwright serves Wisconsin practices remotely, inside the practice management or EHR system the practice already uses. A dedicated biller works the account; nothing is pooled. Each service below explains what that biller does.
- Medical billingClaims worked by one named biller
- CredentialingEnrollment, CAQH and PECOS kept current
- Eligibility verificationCoverage and benefits checked before visits
- Prior authorizationAuths requested, tracked, attached to claims
- Denial managementEvery denial read, worked and appealed
- A/R follow-upUnpaid claims chased before filing limits
FAQ
Questions from Wisconsin practices
What is the Wisconsin Medicaid timely filing limit?
Which HMOs do we contract with for BadgerCare Plus and Medicaid SSI?
Which law sets prompt pay for insurers in Wisconsin?
Why did our Wisconsin personal care claim deny with EOB 1047?
How do our Medicaid patients in Wisconsin get a ride to an appointment?
Where do Wisconsin Medicaid fee-for-service claims go?
Does Wisconsin require EVV for home care visits?
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