Claims Submission
Claims Submission Options
Paper Claims Submission
Providers submitting paper claims are required to use the CMS 1500 claim form. Wisconsin Medicaid denies claims for services submitted on any other paper claim form than the CMS 1500 claim form. Refer to Appendices 4 through 6 of this handbook for the CMS 1500 completion instructions and sample claim forms.
Wisconsin Medicaid does not provide the CMS 1500 claim form. The form may be obtained from any federal forms supplier.
Submit completed forms to:
Wisconsin Medicaid
Claims and Adjustments
6406 Bridge Rd
Madison WI 53784-0002
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Chiropractic Services Handbook
PHC 1306, October 2004