• General Information
  • Introduction
  • Provider Certification
  • Eligibility Criteria
  • Applications
    • Introduction
    • Obtaining Forms
  • Eligibility Verification
  • Duration of Benefits
    • Introduction
    • Extensions
  • Applying for Full-Benefit Medicaid
  • Covered Services
  • Claims
• Appendix
  • Appendix 1 — Instructions for Completing the Presumptive Eligibility for Pregnant Women Application
  • Appendix 2 — Sample Presumptive Eligibility for Pregnant Women Application
• PDF

General Information

Claims

Providers should delay submitting claims for services provided to these women for one week from the eligibility start date to ensure the eligibility information is transmitted to Wisconsin Medicaid and to prevent claims from being inappropriately denied.

Wisconsin Medicaid accepts properly completed and submitted claims for covered services provided to women with a PE for Pregnant Women Benefit identification card as long as the date of service is within the dates of eligibility as shown on the card.

If Wisconsin Medicaid denies a claim with an eligibility-related explanation, even though the provider verified the woman’s eligibility before providing the service, a good faith claim may be submitted. Refer to the Claims Information section of the All-Provider Handbook for information about submitting good faith claims.

Next — Appendix 1 — Instructions for Completing the Presumptive Eligibility for Pregnant Women Application
Previous — General Information, Covered Services