• General Information
  • Introduction
  • Usual and Customary Charges
  • Acceptance of Payment
    • Introduction
    • Maximum Allowable Fees
• Submission Deadline
  • Introduction
  • Medicaid Claims
  • Crossover Claims
  • Exceptions to the Submission Deadline
• Claims Submission
  • Introduction
  • Transactions and Forms
  • Submission Options
    • Introduction
    • Electronic Claims
    • Paper Claims
  • Copayment Amounts
  • State-Contracted Managed Care Organizations
    • Introduction
    • Extraordinary Claims
  • Noncertified Providers
• Responses to Claims Submission
  • Introduction
  • Claim Number
  • Remittance Information
    • Introduction
    • Electronic Remittance Information
    • Paper Remittance and Status Report
  • Verifying Accuracy of Claims Processing
    • Introduction
    • Split Claims May Appear Separately
  • Verifying the Check Amount on Remittance and Status Reports
  • Claim Status
• Adjustment Requests
  • Introduction
  • Electronic Adjustment Requests
    • Introduction
    • Provider Electronic Solutions Software
  • Paper Adjustment Requests
  • Follow-Up to Adjustment Requests
• Good Faith Claims
• Timely Filing Appeals Requests
• Overpayments
  • Introduction
  • Return of Overpayments Through Adjustment Requests
    • Introduction
    • Electronic Adjustment Requests
    • Paper Adjustment Requests
  • Return of Overpayments with Cash Refunds
  • Adjustment Request vs. Cash Refund
  • Medicaid-Initiated Adjustments
• Appendix
  • Appendix 1 — Allowable Exceptions to the Submission Deadline
  • Appendix 2 — Interpreting Claim Numbers
  • Appendix 3 — Sample Remittance and Status Report
  • Appendix 4 — Reading the Remittance and Status Report
  • Appendix 5 — Reading Adjustments on the Remittance and Status Report
  • Appendix 6 — Adjustment/ Reconsideration Request Completion Instructions
  • Appendix 7 — Adjustment/ Reconsideration Request Form
  • Appendix 8 — Explanation of Benefits Codes That Qualify for Good Faith Claims Submission
  • Appendix 9 — Timely Filing Appeals Request Form
  • Appendix 10 — Claim Refund Completion Instructions
  • Appendix 11 — Claim Refund Form
• PDF

Select a section » Certification and Ongoing Responsibilities Claims Information Coordination of Benefits Covered and Noncovered Services Informational Resources Managed Care Prior Authorization Recipient Eligibility

 

 

Claims Information

Responses to Claims Submission

Remittance Information

Paper Remittance and Status Report

Wisconsin Medicaid sends a paper Remittance and Status (R/S) Report once a week to all providers who had at least one claim or adjustment request finalized that week. Each R/S Report includes the following:

• Remittance information for all claims and adjustments processed that week, regardless of whether they are reimbursed or denied. However, denied claims submitted using the NCPDP 5.1 transaction will not appear on Medicaid remittance information.
• A numeric Explanation of Benefits (EOB) code that is specific to Wisconsin Medicaid and corresponds to a printed message about the status or action taken on a claim, claim detail, adjustment, or adjustment detail. A list of the EOB codes used, with their description, appears on the last page of each R/S Report.
• A banner page with R/S Report messages that provide important, time-sensitive information for providers. Refer to the Informational Resources section of this handbook for more information about obtaining R/S Report messages.

Refer to the following appendices for more information about reading R/S Reports:

• Refer to Appendix 3 of this section for a sample R/S Report.
• Refer to Appendix 4 of this section for instructions about reading the R/S Report.
• Refer to Appendix 5 of this section for instructions about reading adjustments on the R/S Report.

Obtaining Copies

Wisconsin Medicaid provides initial R/S Reports at no cost to providers. Additional copies are available for a fee. Providers may request additional copies of R/S Reports by calling Provider Services at (800) 947-9627 or (608) 221-9883 or by sending a written request to the following address:

Wisconsin Medicaid
Written Correspondence
6406 Bridge Rd
Madison WI 53784-0005

When sending written requests, providers should include the following:

• Provider name.
• Provider number.
• Date(s) of the R/S Report(s) being requested.

Next — Responses to Claims Submission, Verifying Accuracy of Claims Processing
Previous — Responses to Claims Submission, Remittance Information, Electronic Remittance Information