MedStats Billing delivers end-to-end revenue cycle management built for Wisconsin practices. We hold insurers to the 30-day rule in Wis. Stat. § 628.46 and claim the 12% interest on overdue amounts, defend work injury fees against the department’s certified database standard rather than accepting repricing, and verify BadgerCare Plus HMO enrollment before every visit.
Wisconsin is the rare state that never adopted a workers’ compensation fee schedule. Instead, a disputed fee is tested against a department-certified charge database, and a provider who can show the case was harder than usual may defend a fee above the statutory threshold. Commercial claims run on a 30-day clock with 12% interest. And Medicaid is fragmented across a large field of BadgerCare Plus HMOs while some members remain fee-for-service entirely, so enrollment has to be checked before every visit rather than assumed from the card.
Wisconsin Billing Specializations:
Prompt Payment of Claims (Wis. Stat. § 628.46) — An amount is overdue if not paid within 30 days after the insurer receives written notice of the fact and amount of the loss, and overdue amounts bear simple interest at 12% per year. We calendar that date from the submission record rather than the payer’s acknowledgement.
No Workers’ Compensation Fee Schedule — Wisconsin prices work injury care against reasonableness rather than a published maximum, which means a reduction is an argument, not an arithmetic result. Practices that treat a repricing letter as final give up ground the statute lets them hold.
The Certified Database Standard (§ 102.16(2)) — The Department of Workforce Development must find a disputed fee reasonable, and order it paid, where the fee is at or below the mean fee for that procedure plus 1.2 standard deviations, as shown by a database the department certifies. Above that line the department orders a reasonable fee instead.
The Complexity Exception — Even above the threshold, the fee stands where the provider proves to the department’s satisfaction that a higher fee is justified because the service in that case was more difficult or more complicated to provide than in the usual case. That is a documentation exercise, and it is winnable.
Necessity of Treatment Disputes — The department’s authority extends to the reasonableness and necessity of treatment provided to an injured employee, so a carrier’s clinical objection is resolved administratively rather than by write-off.
BadgerCare Plus HMO Enrollment — Wisconsin Medicaid contracts with a wide field of HMOs including UnitedHealthcare Community Plan, Dean Health Plan, Chorus Community Health Plans, Anthem Blue Cross Blue Shield, Quartz, Network Health Plan, Security Health Plan, MHS Health Wisconsin, Molina Healthcare, MercyCare, Independent Care Health Plan and both Group Health Cooperatives. Not every member is enrolled in an HMO, and eligibility plus HMO status must be verified before each visit.
ForwardHealth Submission Rules — Enrollment, eligibility verification, claims and prior authorization all route through the ForwardHealth portal, with HMO-specific rules layered on top of the state programme. We work both levels rather than one.
Long-Term Care Programmes — Family Care, Family Care Partnership, IRIS self-direction and the Children’s Long-Term Support waiver sit outside the standard HMO structure with their own authorization and billing paths, and mis-routing those claims is a predictable denial.
Auto Injury Coordination — Wisconsin is an at-fault state with no personal injury protection mandate and no auto medical fee schedule, so auto injury care is billed to optional medical payments coverage, health coverage or third-party liability at reasonable charges, with subrogation and lien tracking deciding what the practice keeps.
Major Wisconsin Payers — Anthem Blue Cross and Blue Shield of Wisconsin, Aurora Health Care and Advocate plans, Quartz, Security Health Plan, Dean Health Plan, Network Health, Aetna, Cigna and UnitedHealthcare denial workflows.
Built to bring clarity, control and consistency to your Wisconsin practice’s revenue cycle.
MedStats Billing manages the complete revenue cycle for Wisconsin providers — from ForwardHealth enrollment and BadgerCare Plus HMO credentialing, through coding, claim scrubbing and submission, to denial resolution, 12% interest recovery and fee and necessity disputes before the Department of Workforce Development.
Certified CPT, ICD-10-CM, and HCPCS coding with pre-submission claim scrubbing built around each payer's edits, so claims pay on the first pass. We manage charge entry, claim submission, payment posting, and insurance follow-up.
Explore service
Enrollment with Medicaid managed care plans, Medicare via PECOS, and commercial payers — plus CAQH maintenance and re-credentialing deadline tracking, so your providers stay in-network and billable without gaps.
Explore service
Coverage confirmed before the visit — active policy status, deductibles, co-pays, plan type, and prior authorization requirements — so front-end denials are caught while there is still time to fix them.
Explore service
Aged claims worked by payer and denial reason, with appeals filed inside each plan's window. We monitor outstanding balances, manage rejections, and drive down days in A/R to protect cash flow.
Explore service
A detailed review of coding accuracy, documentation standards, and denial patterns that identifies revenue leakage and compliance exposure — before a payer audit finds it for you.
Explore serviceLocal SEO, Google Business Profile optimization, and reputation management built for medical practices — helping the patients already searching for your specialty find you first.
Explore serviceWisconsin practices lose more revenue to accepted repricing and unverified enrollment than to coding, and the work injury rules in particular reward practices that argue. These are the four we eliminate:
Wisconsin has no workers’ compensation fee schedule, so a reduction is a claim about reasonableness rather than a calculation. The department decides the question against a certified database, and a fee at or below the statutory threshold must be ordered paid in full.
An amount is overdue if it is not paid within 30 days after the insurer receives written notice of the fact and amount of the loss, and overdue amounts carry simple interest at 12% per year. Practices rarely date that notice, so the interest is never calculated and never claimed.
A fee above the database threshold still stands where the provider proves the service in that case was more difficult or more complicated than usual. That proof lives in the operative note and the record, and it has to be assembled at the time of service rather than reconstructed a year later during the dispute.
Not every BadgerCare Plus member is enrolled in an HMO — some remain fee-for-service with access to any Medicaid-enrolled provider — and HMO assignment changes. Eligibility and HMO status must be verified before each visit, because a claim sent to the wrong entity is denied on routing alone.
An amount payable is overdue if it is not paid within 30 days after the insurer receives written notice of the fact and amount of the loss, and overdue amounts bear simple interest at the rate of 12% per year. Establishing the notice date from your own submission record, rather than the payer’s acknowledgement, is what makes that interest collectable.
Wisconsin resolves work injury fee disputes administratively. The Department of Workforce Development must find a disputed fee reasonable and order it paid where the fee is at or below the mean for that procedure plus 1.2 standard deviations under a department-certified database, and must order a reasonable fee where it sits above that line unless the provider proves a higher fee is justified by the difficulty or complexity of the case.
Wisconsin never adopted a workers’ compensation medical fee schedule. Reimbursement turns on whether the charge is reasonable, measured against certified charge data, and the department also decides disputes about the reasonableness and necessity of the treatment itself. That makes documentation, not arithmetic, the determinant of what a work injury claim pays.
Wisconsin Medicaid contracts with a large field of BadgerCare Plus HMOs, including UnitedHealthcare Community Plan, Dean Health Plan, Chorus Community Health Plans, Anthem Blue Cross Blue Shield, Quartz, Network Health Plan, Security Health Plan, MHS Health Wisconsin, Molina Healthcare, MercyCare, Independent Care Health Plan and the Group Health Cooperatives, while some members remain fee-for-service. Family Care, Family Care Partnership, IRIS and the Children’s Long-Term Support waiver run separately.
MedStats Billing provides tailored billing solutions for a wide range of medical specialties, ensuring accurate coding, fewer denials, and faster reimbursementsto maximizes your revenue potential.
MedStats Billing handles ForwardHealth enrollment, BadgerCare Plus HMO credentialing, 30-day clock tracking, 12% interest recovery and work injury fee and necessity disputes across Wisconsin, giving practices end-to-end RCM support in a state where reimbursement is argued rather than looked up.
Claims are scrubbed against BadgerCare Plus HMO and commercial payer edits before submission to drive clean first-pass reimbursement.
Work injury charges are documented and defended against the certified database standard, including the complexity justification, instead of being written down to whatever the payer reprices them to.
We date the written notice of loss on every claim and pursue the 12% interest Wisconsin attaches to overdue amounts, rather than absorbing it.
Working knowledge of Anthem Blue Cross and Blue Shield of Wisconsin, Quartz, Dean Health Plan, Security Health Plan, Network Health, Aetna, Cigna, UnitedHealthcare and the BadgerCare Plus HMOs.
Whether you practise in Milwaukee, Madison, Green Bay, Kenosha or Eau Claire, our workflows adjust seamlessly as your group grows across the state.
HIPAA-compliant data handling and controlled access protect patient health information and billing records at every stage.
We integrate smoothly with widely used EHR platforms to ensure accurate data flow from documentation to claim submission. This reduces manual errors, speeds processing, and supports cleaner reimbursements.
We work alongside leading systems including:
Schedule a complimentary billing assessment with MedStats Billing to uncover hidden revenue loss, review the work injury reductions your practice has absorbed without a dispute, and quantify the 12% interest owed on overdue claims.
Under Wis. Stat. § 628.46 an amount payable becomes overdue if it is not paid within 30 days after the insurer receives written notice of the fact and amount of the loss. Overdue amounts bear simple interest at the rate of 12% per year. The practical requirement is proof of when that notice was received, which is why submission records and clearinghouse acknowledgements matter as much as the claim itself.
No. Wisconsin prices work injury care by reasonableness rather than a published maximum. Where a fee is disputed, the Department of Workforce Development compares it against a database the department certifies and must order the fee paid if it is at or below the mean fee for that procedure plus 1.2 standard deviations from that mean. Above that threshold the department orders a reasonable fee instead.
Yes. The statute allows a fee above the threshold to stand where the health service provider proves to the department’s satisfaction that the higher fee is justified because the service provided in that case was more difficult or more complicated to provide than in the usual case. That makes contemporaneous documentation of complexity a revenue issue, not just a clinical one.
The Department of Workforce Development resolves disputes about the reasonableness and the necessity of treatment provided to an injured employee, so a carrier’s clinical objection is an administrative question rather than a final answer. Its authority runs to the treatment provided, and it may also set aside, reverse or modify its own determination within 30 days of issuing it.
BadgerCare Plus contracts with a wide field of HMOs, including UnitedHealthcare Community Plan, Dean Health Plan, Chorus Community Health Plans, Anthem Blue Cross Blue Shield, Quartz, Network Health Plan, Security Health Plan, MHS Health Wisconsin, Molina Healthcare, MercyCare Insurance Company, Independent Care Health Plan and the Group Health Cooperatives of Eau Claire and South Central Wisconsin. Not all members are enrolled in an HMO; some remain fee-for-service, so eligibility and HMO status are verified before each visit.
Wisconsin is an at-fault state with no personal injury protection mandate and no auto medical fee schedule, so auto injury treatment is billed at reasonable charges to optional medical payments coverage, the patient’s health plan, or the at-fault driver’s liability coverage. Coordination of benefits order, subrogation and attorney liens determine what the practice ultimately keeps, so those are tracked from the first visit.
We serve practices and healthcare facilities statewide, including Milwaukee, Madison, Green Bay, Kenosha, Racine, Appleton, Waukesha, Eau Claire, Oshkosh, Janesville, West Allis, La Crosse, Sheboygan and Wausau.
