Introduction

Provider Electronic Solutions (PES) is Health Insurance Portability and Accountability Act (HIPAA)-compliant software used for submitting claims to BadgerCare Plus, Wisconsin Medicaid, and the Wisconsin Well Woman Program (WWWP). PES software cannot be used for submitting claims to Medicare or other commercial health insurance payers. EDS, the current Medicaid fiscal agent, supports the PES software. PES is available only to BadgerCare Plus and Wisconsin Medicaid providers and electronic billing services and will allow them to submit HIPAA-compliant electronic claims and adjustments to BadgerCare Plus, Wisconsin Medicaid, and WWWP. This includes the 837 Health Care Claim Dental (commonly referred to as the 837D), the 837 Health Care Claim Professional (or 837P), and the 837 Health Care Claim Institutional (or 837I). Provider Electronic Solutions software will instruct you at the appropriate time to select Wisconsin Medicaid or WWWP.

This manual is intended only to provide information specific to the electronic submission of claims. Providers should continue to refer to their BadgerCare Plus, Wisconsin Medicaid, or WWWP billing manuals for general information on how to bill their claims. This manual is not intended to replace, supersede, or contradict existing BadgerCare Plus, Wisconsin Medicaid, or WWWP guidelines (i.e., benefit limitations or exclusions). All existing program guidelines, instructions, manuals, bulletins, etc. continue to apply as appropriate to all claims submitted electronically, and should be referred to on a continuing basis.

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