Please follow the Enrollment Instructions below to become an electronic submitter for Wisconsin Medicaid.
Required Documents for those applying for new Submitter IDs
The following documents are required enrollment documents that must be completed, signed, and returned tot he Wisconsin Medicaid office prior to initiation of electronic claims submission or inquiry.
1. Trading Partner Profile (Submit Online)
Click on Trading Partner Profile then click on Submit Online
If you have any questions regarding any of the documents in this package, please call the Wisconsin Medicaid EDI Technology Support Center at 1-866-416-4979.
We can now process 276/277 requests (claim status). If this is a transaction you would like to utilize please make sure to enroll with the payer.
Trading Partner Information
You are the Trading Partner, therefore you must complete the Trading Partner Section with your Information.
For Type of Submission, choose "Initial Submission" if you are a new applicant
For the Transaction Sets choose the following:
837...Institutional if you will be sending Institutional claims (UB04)
837...Professional if you will be sending Professional claims (CMS 1500)
835...Payment Advice if you want to receive your EOBs electronically
For the Authorized Representative section, enter your main Biller's information.
Once Wisconsin Medicaid receives your form they will send you a letter containing a PIN. When you receive that PIN you will need to go to www.forwardhealth.wi.gov and set yourself up an account. Once your account is setup, you will need to complete their EDI User Registration process and give your ClaimShuttle Support team a call at 602-439-2525 for assistance uploading your first Test Batch to WI Medicaid.
Please have 5 claims ready for testing. Test files should consist of a variety of claims that represent the type of claims you will be submitting once production status is achieved. Test claims will not be processed for payment but will be validated against production files; therefore, they must contain valid patient procedure, diagnosis, and provider information.