• Eligibility Categories
  • Introduction
  • Medicaid Recipients
  • BadgerCare Recipients
  • Wisconsin Well Woman Medicaid
  • Limited Benefit Categories
    • Introduction
    • Family Planning Waiver Program
    • Presumptive Eligibility for Pregnant Women Benefit
    • Tuberculosis-Related Services-Only Benefit
    • Qualified Medicare Beneficiary-Only Recipients
    • Specified Low Income Medicare Beneficiaries
    • Qualifying Individual 1 Recipients
    • Qualified Disabled Working Individual Recipients
• Medicaid Identification Cards
  • Introduction
  • Forward Cards
    • Introduction
    • Forward Card Features
    • Identification Number Changes
    • Recipient Name Changes
    • Deactivated Cards
    • Defective Cards
    • Lost Cards
    • Managed Care Organization Enrollment Changes
  • Temporary Medicaid Cards
  • Presumptive Eligibility for Pregnant Women Temporary Cards
  • Presumptive Eligibility for the Family Planning Waiver Program Temporary Cards
• Eligibility Verification Methods
  • Introduction
  • 270/271 Transactions
  • Automated Voice Response System
    • Introduction
    • Dates of Services
    • Hours
  • Commercial Eligibility Verification Vendors
    • Introduction
    • Magnetic Stripe Card Readers
    • Personal Computer Software
    • Internet Access
  • Provider Services
    • Introduction
    • Hours
  • Recipient Forgets Identification Card
• Eligibility Rights
  • Introduction
  • Prompt Decisions on Eligibility
  • Requesting Retroactive Eligibility
  • Appealing Eligibility Determinations
    • Introduction
    • Claims for Appeal Reversals
  • Freedom of Choice
  • Notification of Discontinued Benefits
• Eligibility Responsibilities
  • Introduction
  • Prior Identification of Eligibility
  • Loss of Medicaid Eligibility — Financial Liability
  • Reporting Changes to Caseworkers
• Copayment Requirements
  • Introduction
  • Copayment Exemptions
  • Copayment Amounts
  • Copayment Limitations
  • Copayment Refund/Collection Requirement
• Special Eligibility Circumstances
  • Retroactive Eligibility
    • Introduction
    • Reimbursing Recipients in Cases of Retroactive Eligibility
  • Spenddown to Meet Medicaid Financial Eligibility Requirements
  • Persons Detained by Legal Process
  • Recipients Traveling Out of State
  • Non-U.S. Citizens — Emergency Services
  • Medicaid Recipients from Other States
• Misuse and Abuse of Benefits
  • Introduction
  • Examples of Misuse and Abuse
  • Requesting Additional Proof of Identity
  • Notifying Wisconsin Medicaid
  • Providers May Refuse to Provide Services
  • Recipient Lock-In Program
    • Introduction
    • Providers May Make Referrals
• Appendix
  • Appendix 1 — Limited Benefit Categories
  • Appendix 2 — Quick-Entry Guide for the Automated Voice Response System
  • Appendix 3 — Eligibility Verification Vendors
  • Appendix 4 — Certification of Emergency for Non-U.S. Citizens Form Completion Instructions
  • Appendix 5 — Certification of Emergency for Non-U.S. Citizens
• 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

 

 

Recipient Eligibility

Appendix

Appendix 2 — Quick-Entry Guide for the Automated Voice Response System

The following entry strings can be used to check eligibility on the Automated Voice Response (AVR) system quickly. Information on the chart that is shown between brackets ( [ ] ) is entry information specific to the provider, recipient, or date(s). Numerical values and the pound sign (#) indicate direct telephone keypad entries. Information may be entered prior to voice prompts, as long as it is entered in the appropriate sequence. At any point during the voice prompts, providers may skip to the next segment of information by pressing “1.”

Generally, providers cannot request eligibility information for future dates. However, if the provider verifies eligibility for the current date and this date is after the 20th of the month, eligibility for the following month and the current month may be provided. Providers may obtain information from the AVR system by calling (800) WIS-ELIG (947-3544) or (608) 221-4247.

Type of Eligibility Search	Entry String
Current date by entering a recipient identification number	1, 1, [provider number], #, 1, 1, [recipient identification number], #, 1, #, #
Current date by entering the recipient’s date of birth (DOB) and Social Security number (SSN)	1, 1, [provider number], #, 1, 2, [DOB - MMDDCCYY], #, 1, [SSN], #, 1, #, #
Specific date by entering a recipient identification number	1, 1, [provider number], #, 1, 1, [recipient identification number], #, 1, [date from - MMDDCCYY], #, [date to - MMDDCCYY], #
Specific date by entering DOB and SSN	1, 1, [provider number], #, 1, 2, [DOB - MMDDCCYY], #, 1, [SSN], #, 1, [date from - MMDDCCYY], #, [date to - MMDDCCYY]

Next — Appendix 3 — Eligibility Verification Vendors
Previous — Appendix 1 — Limited Benefit Categories