Claims

Partnership, Dual Advantage, and legacy Care Wisconsin Family Care member claims are processed by our Third Party Administrator (TPA), Cognizant. If you have a specific billing and/claims inquiry, please call 1-855-878-6699 to speak with a claims representative.

All other Family Care claims are processed by our TPA, WPS. If you have a specific billing and/claims inquiry, please call 1-800-223-6016 to speak with a claims representative.

Cognizant (New and corrected claims)

My Choice Wisconsin
P.O. Box 7000
Columbia, MD 21045

WPS (New and corrected claims)

Mail: My Choice Wisconsin
C/O WPS Health
P.O. Box 211595 Eagan, MN  55121

Providers can now submit via fax to 608-327-6332 instead of mailing.

• For new and corrected claims, please do not include a fax cover sheet. You may fax just the claim form or just the Corrected Claim Form and normal supporting documents (PRA).

Trilogy Health Networks (New and corrected claims)

Trilogy Health Networks
P.O. Box 1171
Milwaukee, WI 53201

Pharmacy

Medicare Only – Partnership/Dual Advantage Pharmacy – Elixir
Toll-free: 844-550-6814
BIN: 012312
PCN: PartD

Dental

Partnership and Dual Advantage – DentaQuest of WI
DentaQuest of WI – Claims
P.O. Box 2906
Milwaukee, WI 53201-2906
Phone: (855) 453-5287 for providers

Vision

Partnership and Dual Advantage – EyeQuest of WI
EyeQuest of WI – Claims
P.O. Box 433 
Milwaukee, WI 53201-0433
Phone: 844-824-2014  
Fax: 888-696-9552

My Choice Wisconsin accepts standard electronic billing for Professional and Institutional claims (837P or 837I, as appropriate).

• For claims processed by TriZetto/Cognizant, the Payer ID is 27004.
• For claims processed by WPS, the Payer ID is SX022.

MIDAS portal
TriZetto/Cognizant claims portal

To learn about the electronic funds transfer process, please click on the appropriate link below:

Cognizant (Trizetto) EFT Form

WPS EFT

• My Choice Wisconsin will pay your claim within 30 days after receipt of a complete and accurate claim for an eligible member. 
• Claims must be submitted to My Choice Wisconsin Health Plan within 120 days of the date of service or of discharge or the timeframe specified within the providers’ contract. Timely filing limits will vary by contractual agreement with My Choice Wisconsin Health Plan.  Claim corrections must be submitted within the 120 day timely filing deadline as well.  There is no extension for corrected claims.
• When My Choice Wisconsin Health Plan is the secondary payer due to other insurance coverage, the provider must submit the claim along with the EOB or explanation that payment from the primary carrier. My Choice Wisconsin Health Plan will allow 120 days from the date of the primary carrier’s EOB, or the providers’ contracted limits.

• Mailed claims payments, accompanied by an explanation voucher, are sent after each check cycle, excluding holidays. 
• EFT payments are sent after each check cycle. However, EOBs must be obtained through the Claims Web Portal, the WPS Portal, or your electronic clearinghouse if applicable. 
• My Choice Wisconsin will pay for services that are:
  • Part of the provider’s contract
  • Authorized (if required per guidelines)
  • Provided to a member in the previous month or time period
  • When claim is received within timely filing limit per contract

Regulations prevent My Choice Wisconsin from paying in advance for services.

If a claim is denied, you will receive an explanation voucher with a reason code and explanation of that code. Claims which are denied or paid incorrectly due to an error on the provider’s end should be resubmitted as a Corrected Claim and mailed to the normal claims address (except for Dental claims). For legacy MCFC members, submit a corrected claim form to the normal WPS claims address. 

Providers may resubmit appeals and claims that has been corrected or modified from the original within 60 days of original payment/denial or the timeframe specified within the providers’ contract.

If you need clarification on a denial, please contact the appropriate TPA:

• Cognizant – 1-855-878-6699
• WPS – 1-800-223-6016

If you need clarification on a dental denial, please contact DentaQuest:

• 855-453-5287

If you need clarification on your vision denial, please contact EyeQuest: 

• 844–824-2014 

If you still believe a denial was in error or there are extenuating circumstances you would like us to consider, you may send an appeal to My Choice Wisconsin using our Appeal Form.

Cognizant Claims Appeals

My Choice Wisconsin by Molina Healthcare
Attn: Claims Appeals
5117 W. Terrace Drive, Suite 100
Madison, WI  53718

Non-contracted providers must attach a Waiver of Liability form to any appeal of Medicare-covered services.

WPS Claims Appeals

Attn: Claims Appeals
10201 W Innovation Dr.
Wauwatosa, WI  53226

Dental Claims Appeals

DENTAQUEST of WI – Claims  
Attn: Appeals Department  
P.O. Box 2906 Milwaukee, WI 53201-2906  

Fax: (262) 834-3452 

Vision Claims Appeals

EYEQUEST of WI – Claims  
Attn: Appeals Department  
P.O. Box 2906  
Milwaukee, WI 53201-2906   

Phone: 844-824-2014 

Email: VisionCGA@dentaquest.com 

If you disagree with our appeal decision for Family Care or Partnership members, you may submit a second level appeal to the State of Wisconsin at:

Fax: (608) 266 – 5629
Or Mail: Provider Appeal Investigator
                Division of Medicaid Services
                1 West Wilson Street, Room 518
                P.O. Box 309
                Madison, WI  53701-0309

Family Care, Partnership, and Dual Advantage Members

If a member carries other insurance through more than one insurer, My Choice Wisconsin will coordinate the benefits to ensure maximum coverage without duplication of payments. The Provider Handbook has more details on coordination of benefits.

If traditional Medicare is the primary carrier:

• In many cases where traditional Medicare is the primary carrier, Medicare will automatically forward claims to My Choice Wisconsin. 
• If your Medicare Remittance Advice indicates that the claim was forwarded to My Choice Wisconsin, you should not submit a claim to My Choice Wisconsin.
• If your claim has not been processed within 60 days of the Medicare Remittance Advice, please submit your claim to My Choice Wisconsin, with a paper copy of the Medicare Remittance Advice, to the appropriate TPA, address listed above.

For all other insurance carriers:

• Providers must submit claims to the primary insurance before submitting to My Choice Wisconsin. 
• Following the primary insurance determination, paper copies of both the original claim form and the primary insurance Remittance Advice must be submitted to My Choice Wisconsin for secondary benefit determination (regardless of balance due). My Choice Wisconsin cannot accept secondary claims electronically.
• Providers must submit the documents within 120 days from the date on the primary RA.