Statewide Healthcare RCM Coverage • 792 Cities & Towns
Medical Billing & RCM Services in Wisconsin
Delivering tailored medical coding, billing, and credentialing services across Wisconsin. Serving healthcare providers, clinics, and hospital groups with an exceptional 98% clean claim rate.
Statewide Regulatory & MAC Compliance Hub
Wisconsin Medicare MAC Jurisdiction & Payer Regulations (J-6)
Comprehensive Part A/B Medicare contractor policies, LCD standards, and state Medicaid filing rules for Wisconsin medical practices.
98.2% First-Pass Clean Claim Rate
Medicare Administrative Contractor (MAC)
J-6
Jurisdiction 6 (J-6)
Contractor:
National Government Services, Inc. (NGS) (HQ: Indianapolis, IN)
State Medicaid & Public Health Agency
WI
Wisconsin Department of Health Services (ForwardHealth)
Governing Agency:
Wisconsin Department of Health Services (DHS)
Medicaid Timely Filing:
365 days from Date of Service
Medicare Timely Filing Window
12 months (365 days) from Date of Service
First-Level Appeals (Redetermination)
120 calendar days from Remittance Advice (Redetermination)
First-Pass Clean Claim Target
98.2% Scrubber Rate
Active Local Coverage Determinations (LCDs) in Wisconsin (J-6):
4 Active LCDs
L33580
Non-Invasive Vascular Testing
L33632
Psychiatric Partial Hospitalization Programs (PHP) & Psychotherapy
L33587
Colorectal Cancer Screening & Colonoscopy
L33618
Cardiac Rehabilitation Programs
Regional Billing Nuances & Compliance Safeguards:
Illinois HFS / IMPACT Portal: Illinois Medicaid requires provider re-validation in IMPACT; automated cross-over 835 files matched via Provider Category of Service (COS).
Minnesota MHCP & Wisconsin ForwardHealth: Real-time cross-over 837P reconciliation; electronic Additional Documentation Request (ADR) fulfillment via NGSConnex within 45 days.
Non-Invasive Vascular: Separate billing of -26 (professional) and -TC (technical) components.
Mandatory single-use drug vial wastage recording with JW/JZ modifiers.
Healthcare Locations & Cities in Wisconsin
Select your city below for specialized local medical billing solutions and regional payer expertise.