Wisconsin Medicaid Updates Guidelines for OB Antepartum Care Claims
Any healthcare provider in Wisconsin who submits obstetric antepartum care claims needs to follow the latest state-specific procedures to prevent claim denials. ForwardHealth, the state Medicaid program, requires antepartum care claims with four or more visits to submit only the last visit date vice including multiple visit times within a range.
The guideline specifies that providers who offer antepartum care can get reimbursement through just one claim during a pregnancy period that involves a single member and one billing provider (ForwardHealth, Topic 1251). Providers who submit claim denials when using a date span for all visits should avoid doing this practice.
Key Steps for Submitting Antepartum Care Claims:
- All antepartum medical appointments need to be completed before billing the claim.
- Financial reimbursement requests should consist of one combined submission including all visits from antepartum care.
- Healthcare providers should use the UnitedHealthcare Provider Portal together with electronic data interchange (EDI) and fax machine technology for claim submission.
Required Coding and Modifiers:
- CPT® code 59425: For antepartum care, 4-6 visits.
- CPT® code 59426: For antepartum care, 7-8 visits.
- Modifier AQ: To be included with the CPT® code.
- Quantity: Enter "1" for the quantity field.
- Date of service: Use the date of the last visit only.
The specific details available for claim handling regarding obstetric care components can be found on Wisconsin.gov under ForwardHealth topic 1251, and UnitedHealthcare provides 24/7 Provider Portal chat assistance to providers.
Compliance with these changed requirements helps to produce reliable reimbursement while stopping rejected claims from occurring. Additional support for providers is available through detailed options listed on UnitedHealthcare’s Contact Us page.
