For detailed information on the claims process, please see our Claims page. Please contact the appropriate TPA with claims questions:
Partnership, SSI, Dual Advantage, and legacy Care Wisconsin Family Care member claims are processed by Cognizant (Trizetto): 1-855-878-6699.
All other Family Care claims are processed by WPS: 1-800-223-6016.
For detailed information on the authorizations process, please see the Authorizations page.
Family Care members – authorization is required prior to rendering ALL services for Family Care. You must contact the member’s care team to get an authorization; providers will be able to see and/or print the authorization from the MIDAS portal.
SSI, Partnership, and Medicare Dual Advantage Members – please use the My Choice Wisconsin form appropriate for the service and fax to (608) 210-4050.
Authorizations do not display in MIDAS until 5 days before the start date of the authorized service.
No, you can submit your claims the way you always have. The use of MIDAS for claims submission is not required.
All claims submitted through the MIDAS portal are in process. Because this is a new process for legacy Care Wisconsin providers, there will be a short delay in payment. Do not resubmit the claims or you will delay your payment further due to duplicate claims in the system.
The MIDAS system displays either the MIDAS Member ID or (if printed) the member’s SSN. These numbers should NOT be used for claim submission. You should use the Care Wisconsin Member ID or the member’s Medicaid ID. Please know My Choice Wisconsin is working to remove all member SSNs from printing and distribution.
The additional insured endorsement extends your liability coverage to the MCO to address any additional liability exposure you potentially create for us in the course of providing services. The Certificate of Insurance should list My Choice Wisconsin Inc. as the additional insured.
Rates are negotiated between each individual provider and our managed care organization. Because the MCO receives varied capitation rates between counties served, not all rates will be the same.
There are many factors that go into the contracting process. The credentialing and rate negotiation process varies depending on the provider type, size, number of employees, number of locations, and responsiveness to requests for additional information. Generally, the process for contracting takes from 60 to 90 days.
My Choice Wisconsin needs to determine whether Medicare is the primary insurer. There is extensive documentation and requirements that must be met in order to satisfy Medicare approval prior to the receipt of DME products. Because Family Care is a secondary payor source, the primary payor must be established first.
Providers are required to update their bed availability and contact information in the MIDAS Portal prior to submitting claims for billing. Keeping bed availability updated will allow the Residential Team visibility to your bed openings so they can be filled more quickly. When you are listed as having an opening, a member of the care team or residential team will reach out to you via phone or email with appropriate referrals.
Please reference the tutorial for updating bed availability at: MIDAS>User Documents>Provider Portal>Provider Resources>Provider Tutorials> MIDAS Bed Information Tutorial.pdf
When a member needs placement, our residential team works closely with the member’s care team to ensure viable placement options are available for consideration. There are several factors that go into placement decisions, including the member’s ability to afford the room and board at the in-network residential facility of their choice, the provider’s ability to meet the individual member’s needs, and the proximity of placement. Placement is a collaborative process between the member, care team, and guardian, as applicable.
Providers interested in certification through My Choice Wisconsin should reach out to the Contracts and Provider Relations Department (414-287-7640) to determine if and what types of AFH applications are being accepted. If applications are being accepted, please submit a provider application. After an initial screening, the provider will be referred to an AFH Certifier to arrange for certification application and a site visit. Certification guidelines can also be viewed on the Wisconsin DHS website. We will accept previous certifications from another MCO.
As of November 2, 2020, the Wisconsin Department of Health Services (DHS) begins implementing Electronic Visit Verification (EVV) for Medicaid-covered personal care services. Please visit our new EVV webpage or the DHS website for the latest information on EVV including training guides, EVV ForwardHealth Policy, Provider Newsletters, and Podcasts. Contact DHS EVV Customer Care for any questions about EVV Implementation at 833-931-2035 or firstname.lastname@example.org.
As you may know, in the summer of 2019 My Choice acquired Trilogy Health Insurance, Inc. Effective June 1, 2021, the Trilogy Health Insurance BadgerCare Plus program is being rebranded under the My Choice Wisconsin Health Plan Inc. name.
Provider contracts – nothing needs to be done at this time. The name change will not affect claims adjudication.
Administration – SMG has been and will continue to process claims and provide customer service. IPN has been and will continue to provide medical management.
My Choice Wisconsin will not be amending existing BadgerCare Plus contracts at this time.
As of 6/1/2021 they should see: My Choice Wisconsin Health Plan – BadgerCare Plus.
Referrals are no longer needed. There are no changes to the process for authorization requests. BadgerCare Plus providers should follow instructions for authorizations found on theAuthorizations page.
Please use the same contacts you previously had – they are not changing. BadgerCare Plus providers should follow instructions for authorizations found on theAuthorizations page. For a copy of the Quick Reference Contact Sheetclick here.
Our BadgerCare Plus customer service representatives are here to help you 8:00 am to 5:00 pm Monday – Friday. Call us at 855-530-6790.