Claims Appeals


NEW CLAIM APPEAL ADDRESS REMINDER

All claims appeals should be now be sent to:

Community Link, Inc.
Attn: Provider Claims Appeals
1407 St. Andrew St, Suite 100
La Crosse, WI 54603

This applies to ALL dates of service.

(Note: The December 6 ContinuUs Provider Bulletin stated incorrectly that appeals for dates of service prior to 01/01/2017 should be sent to the Lone Rock address.)


Providers have the right to appeal a claim denial or partial claims payment, to Community Link, Inc. (CLI). All payments and/or denials are accompanied by a PRA (Provider Remittance Advice) or a rejection notice, which gives the specific explanation of the payment amount or specific reason for the payment denial.

If you have questions regarding a partial payment or denial that cannot be resolved by the WPS / Family Care Contact Center, please contact CLI Customer Service at 1-888-544-9353 or customerservice@wwcares.org. Your situation will be reviewed and you will be advised of your options. If you have a dispute and it cannot be resolved with CLI Customer Service staff, you will be instructed to file a formal appeal with Community Link.

If you wish to file a formal appeal you must submit a letter that is clearly marked “Appeal” and includes the following:  

  • a. Provider name
  • b. Member name
  • c. Date of service
  • d. Procedure code
  • e. Copy of the WPS Provider Remittance Advice (PRA)
  • f. Copy of the Explanation of Medicare Benefit (EOMB) or other insurance PRA, if applicable
  • g. Reason(s) your claim merits reconsideration (Please provide detailed explanation.)
  • h. Any other documentation to support your appeal

 Your appeal must be submitted in writing within 60 calendar days of the initial WPS denial or partial payment to:

Community Link, Inc.
Attn: Provider Claims Appeals
1407 St. Andrew St, Suite 100
La Crosse, WI 54603

If Community Link fails to respond to the appeal within 45 calendar days or if you are not satisfied with Community Link's response to the reconsideration request, you have the right to appeal to the Department of Health Services (DHS).

All appeals to DHS must be submitted in writing within 60 days of Community Link's final decision or failure to respond. The submission must be clearly marked as an “Appeal” and indicate provider name, address, date of service, date of billing, date of rejection, and reason(s) for the request for reconsideration or appeal. DHS appeals should be sent to:

MCO Contract Administrator
Office of Family Care Expansion
1 West Wilson Street
Room 518
P.O. Box 7851
Madison, WI 53707-7851