Wisconsin Medicaid requirement: Claims must match the Wisconsin Max Fee Schedule to avoid denials

Effective January 2025, claims submitted for UnitedHealthcare Community Plan of Wisconsin members must match the coverage information in the WI Medicaid Max Fee Schedule. If the information does not match, our system will deny your claim.

What you need to do 

Before submitting members’ claims for medical and behavioral health services, please verify the following information against the Max Fee Schedule:

• Professional claims: 
  • Date(s) of service
  • Member’s age
  • Place of service
  • Procedure or CPT^® code
  • Provider type/specialty
• Institutional claims: 
  • Date(s) of service
  • Revenue code
  • Provider type/specialty

Resources

Visit the Wisconsin Department of Health site for more information:

• ForwardHealth Portal
• Online Handbook Display

See the UnitedHealthcare claims, billing and payments page for information about submitting claims, identifying digital tools, finding forms and linking to guides and training opportunities.