Resources : Enrollment Verification

Enrollment Verification System

Member enrollment issues are the primary reason claims are denied. To reduce claim denials, providers should always verify a member's enrollment before providing services, both to determine enrollment for the current date (since a member's enrollment status may change) and to discover any limitations to the member's coverage. Providers may want to verify the member's enrollment a second time before submitting a claim to find out whether the member's enrollment information has changed since the appointment.

Providers can access Wisconsin's EVS to receive the most current enrollment information through the following methods:

• ForwardHealth Portal
• WiCall, Wisconsin's AVR system
• Commercial enrollment verification vendors
• 270/271 transactions
• Provider Services

Providers cannot charge a member, or authorized person acting on behalf of the member, for verifying their enrollment.

The EVS does not indicate other government programs that are secondary to Wisconsin Medicaid.