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Medicaid/CHIP Data Requirements in Wisconsin

        Wisconsin law sets forth recordkeeping requirements for providers participating in Medicaid.  Providers must maintain records for each Medicaid patient treated, and must document the patient’s identifying information and clinical information.  In addition, Medicaid participating providers must maintain financial records that include accounting records, payroll records, and billing claims forms for five years.1  Wisconsin law prohibits the disclosure of Medicaid patient information for any purpose other than for the administration of benefits.2



  • 1. Wis. Admin. Code DHS §106.02; W.S.A. 49.45(3)(f)(1)
  • 2. W.S.A. 49.45(4)


Medicaid/CHIP Data Requirements in Wisconsin

Subtopic Statute/Regulation Description
Mandatory reporting by Medicaid providers (cost/utilization information) Data to be submitted by physician class of provider – Wis. Admin. Code DHS §120-14 Data to be submitted by physicians to DHS The Department of Health Services requires physicians to submit certain kinds of data to them on a regular...
Medicaid medical records maintenance by providers (including retention period, storage, and other recordkeeping requirements) General requirements for provision of services – Wis. Admin. Code DHS §106-02 A provider providing medical assistance may only be reimbursed for covered services as long as the recipient was eligible for medical assistance when...
Other Medical assistance; administration – Wis. Stat. Ann. § 49.45 Medical Assistance; Administration This law sets forth the detailed instructions to the Department of Health Services on running the state's Medical...