Wisconsin Government Programs Information
This page highlights specific documents and forms which apply to Government Programs in this state.
Core Membership
- Please note Optum WI Medicaid Core Members are only covered for outpatient mental health services provided by Psychiatrists (MD/DO) and Nurse Practitioners (APNP). There is no coverage for master’s level therapists or psychologists under this plan.
As a reminder, it is the provider’s responsibility to validate a member’s current eligibility and benefits as authorization does not guarantee payment of services.
Submission of Claims to Optum for WI Medicaid Members
- Network providers should be submitting claims for services rendered to Optum WI Medicaid members in accordance with requirements set forth in the State of Wisconsin’s Medicaid program on line provider manual available on the Forward Health portal. Providers should be submitting claims with all applicable and required modifiers as identified in the WI Medicaid Provider Manual. Claims that are missing required modifiers for the level of service are subject to payment denial.
- For specific requirements for required claims submission fields, please refer to the on line Medicaid Provider Manual on the State of Wisconsin’s Forward Health website.
Provider Medicaid Certification
- Failure to maintain proper WI Medicaid certification may impact payment for services rendered. Optum requires that all Optum WI Medicaid network providers maintain a current and valid Medicaid certification through the State of Wisconsin. Claims submission with a lapse of WI Medicaid certification or inaccurate certification for the service(s) rendered may subject the claim to payment denial.
Please refer back to the Provider Express home page for all other clinical, administrative, network and technical resources.