• 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

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Claims Information

Timely Filing Appeals Requests

When a claim or adjustment request meets one of the exceptions to the submission deadline, the provider may submit a timely filing appeals request. Timely filing appeals requests must be submitted on paper because a national standard for electronic claim attachments has not been established at this time.

Dates of service (DOS) that are beyond the submission deadline should be submitted separately from DOS that are within the deadline. Claims or adjustment requests received by Wisconsin Medicaid that contain both current and late DOS are processed through normal channels without review by Timely Filing. Late DOS will be denied.

To receive Medicaid consideration for an exception to the submission deadline, providers are required to submit the following:

• A properly completed Timely Filing Appeals Request form, HCF 13047 (fillable PDF, 144 KB).
• A legible claim or adjustment request.
• All required documentation as noted in Appendix 1 of this section.

When completing the claim or adjustment request, providers are required to indicate the procedure code, diagnosis code, place of service code, etc., as effective for the DOS. However, providers should use the current claim form and instructions or adjustment request form and instructions. Reimbursement for timely filing appeals requests is contingent upon the claim or adjustment request meeting program requirements for the DOS.

To receive consideration, timely filing appeals requests must be received before the deadlines specified in Appendix 1 of this section.

Decisions on timely filing appeals requests cannot be appealed. Providers may resubmit the claim to Timely Filing if both of the following occur:

• The provider submits additional documentation as requested by Wisconsin Medicaid.
• Wisconsin Medicaid receives the documentation before the specified deadline for the exception.

The Timely Filing Appeals Request form (fillable PDF, 144 KB) is located in Appendix 9 of this section for photocopying and may also be downloaded and printed from the Medicaid Web site.

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