Frequently Asked Questions

FAQ

What is the difference between Medicaid and Medicare?

In broad, general terms, Medicaid is health insurance for the indigent; Medicare is health insurance for the elderly and disabled. Medicaid is a State administered health insurance program overseen by the federal Centers for Medicaid and Medicare Services (CMS). Medicare is a federally administered program. Medicare is also referred to as Title XVIII or T18 of the Social Security Act. Medicaid is referred to as Title XIX or T19 of the Social Security Act. A person may have both Medicaid and Medicare. Wisconsin Medicaid Casualty recovery is only responsible for the identification and recovery of Medicaid paid funds, not Medicare. The Medicare Secondary Payor (MSP) Unit is responsible for the identification and recovery of Medicare funds.

How is it determined who I will get paid claim information from - either HMS, a county and/or an HMO/CMO?

Currently, a casualty/subrogation case will be "worked" according to the county agency that certified the member for Medicaid. Note that the Medicaid member may also be or have been enrolled in a Medicaid HMO/CMO. The Medicaid HMO/MCO has separate statutory authority to a right of recovery for Medicaid services paid on the member‘s behalf. HMS will review each request and inform you of which agency and/or HMO/MCO will provide the lien amount. Please refer to the Who to Contact page for contact information.

Does the State of Wisconsin contribute to attorney‘s fees and costs for recovery in a settlement or lawsuit that involves a Medicaid recipient?

Pursuant to s. 49.89 (5), the reasonable costs of collection including attorney fees shall be deducted first from any settlement or judgment. The amount of assistance granted as a result of the occurrence of the injury, sickness or death shall be deducted next and the remainder shall be paid to the public assistance recipient or other party entitled to payment. See also s. 102.27(b) regarding Workers Compensation claims.

Does a provider have to accept Medicaid payment for a claim when a member is involved in an injury or accident?

No. Providers have two billing options when treating a member who may have a claim arising out of tort or Workers Compensation. They may bill Medicaid directly, ignoring the possibility of being paid in any third party claim settlement, or they may look to the injured member‘s third party claim. If they look to the third party claim, they may change this decision and bill Medicaid, provided they do so within one year of the date of service. If they bill Medicaid, the provider‘s claim becomes the property of Medicaid. The provider may not seek payment from both Medicaid and a personal injury or workers compensation claim. Once a provider accepts the Medicaid payment for services provided to the member, the provider shall not seek or accept payment from the member‘s personal injury or workers compensation claim. See Wisconsin Administrative Code DHS 106.03(8).

How long does it take to get Medicaid paid claims information from the Recovery Unit?

Typically it takes two to three weeks to get paid claims information from Wisconsin Casualty Recovery. Note that in Wisconsin, Medical providers have up to one year from the date of service to bill Medicaid.

Contact Information

Wisconsin Casualty Recovery
HMS Case Management - WI
5615 High Point Drive
Irving, TX 75038-9984
Toll Free:  (877) 391-7471
Fax:  (469) 359-4319
Email:  wicasualty@gainwelltechnologies.com