T19

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    Questions Most Commonly Asked By Providers About Title 19


    Click here for the Title 19 Refund/Write-Off Request form.

    What is T19?

    T19 is the Wisconsin Medicaid Program.


    Why did GAMP pay for our patient when the patient was eligible for Title 19?

          In most cases at the time the patient applied for GAMP, he/she was not on the T19 pro-
    gram but may have had the qualifications to be on T19. The patient is made aware that they are
    eligible for T19 - they apply, and when they are approved - their coverage is backdated by the
    T19 program. In the meantime, GAMP usually has been making payments for the patient's health
    care needs. In addition, GAMP staff and U/R nurses work with patients to review the T19
    eligibility determination and make appropriate referrals to T19 when medical conditions warrant.

    Why does T19 backdate to cover previous time periods?

          Institutionalized and non-institutionalized persons can be eligible back to the 1st of the
    month, 3 months prior to the month of application. Even if they are ineligible in the month of
    application, they may still be eligible for retroactive coverage.

    How do I know when a patient is on T19?

          You will be sent a report entitled Summary of T19 Claims Report from the GAMP offices.
    This report will list T19 eligible clients to whom your facility provided services and were re-
    imbursed. This report also lists their dates of T19 eligibility.

    Why do we owe GAMP a refund?

          When GAMP patients become T19 eligible, all payments during their eligibility period are to
    be refunded to GAMP and the provider is to submit a claim for these services to T19. The
    refunds are then used to reimburse other providers such as hospitals, which have accepted
    a fiscal exposure in their services to GAMP eligible recipients. GAMP is the payer of last resort.

    Why do the GAMP payment checks come from WPS?

          GAMP contracts the WPS to process and pay our claims. This step was taken in 1998 to
    insure prompt and timely payments by GAMP to Medicaid Providers. On an average, WPS/GAMP
    processes 8,000 claims for services each week with an average payment volume of almost
    $1.0 million.

    Why is GAMP billing me when they never paid me?

          Due to the fact that WPS processes the GAMP claims and payments, GAMP payments
    are made to you on WPS checks out of GAMP funds as payment for claims you submitted
    on behalf of services to GAMP eligible clients.

    How soon does GAMP expect reimbursement?

          Reimbursement should be made to GAMP within 30 days of receiving an invoice. Since the
    T19 program has timely submission of claims policies, it is best to address these claims as soon
    as possible.

    When submitting reimbursement to GAMP, what information do you need?

          We ask that you return a copy of the Summary of the T19 Eligible Claims Report marking the
    patient's name and affixing the appropriate invoice number for each patient.

    Can we bill T19 for dates of service over 1 year old?

          Yes. When a patient receives retroactive T19 coverage, these dates of service can be more
    than one year old. Only claims with dates of service over one year old must be billed to the Late
    Billing Unit. For further instructions call the T19 Late Billing number at 1 (800) 947-9627.
    Claims with dates of service less than a year old should be processed through the normal Medicaid
    billing process.

    Can we bill T19 for services not reimbursed by GAMP?

          Under most conditions, GAMP would not issue payment unless the T19 program recognized
    the expense. However, in some cases GAMP denied payment due to limited financial resources.
    Any provider can issue claims to the T19 program for services within their date of service, regardless
    of the GAMP payment status.

    Why should I bill Wisconsin (T19) Medicaid within the 6 month time period?

          To ensure reimbursement from Wisconsin (T19) Medicaid. You are still obligated to pay GAMP
    back even if you do not bill Wisconsin (T19) Medicaid.


    Processing Refunds to GAMP


    It is time to process a refund to GAMP when you have received the following:


    • Letter from GAMP

    • Invoice

    • Summary of T19 Eligible Claims Report


    What do I need to do?


    1. Make a check payable to Milwaukee Treasurer or GAMP for the invoiced amount within
      30 days of receipt of invoice.

    2. When making payments, please send along a copy of the Summary of the T19 Eligible
      Claims Report,       and on it highlight (circle or check) the patients' names and indicate the
      appropriate invoice numbers for which you are submitting payment.

    3. Mail payment and copy of Summary of the T19 Eligible Claims Report with necessary
      notations to:

    GAMP
    P.O. Box 78308
    Milwaukee, WI 53278-0308


    NOW - You need to Bill T19

    You now need to bill T19 for the patients indicated on the Summary of the T19 Eligible
    Claims Report     within 6 months of receipt of the GAMP invoice.


    • Claims with dates of service (DOS) under one year, bill T19 in the usual manner.

    • Claims with a DOS over one year, submit your properly completed claim and a
      copy of the letter sent to you from GAMP to:

    GR Retro-Eligibility
    EDS
    6406 Bridge Road, Suite 50
    Madison, Wisconsin 53784-6215


    T19 Denied My Claim - Now What?


    T19 has denied my claim - How do I get reimbursement for my claims?


    1. Highlight (circle or check) the patient(s) rejection code(s) on the EDS Remittance and Status
      Report. Submit the Status Report and a copy of the rejection code description to:

      GAMP
      1220 W. Vliet St.
      Milwauke, WI 53205


    2. Indicate the invoice number and return a copy of the Summary of the T19 Eligible Claims
      Report       highlighting (circle or check) the patients involved.

    3. If you have paid GAMP for these patients, you can request a refund or credit. You must send
      proof of payment to GAMP in the form of a cancelled check if your original payment to GAMP
      was for partial invoice or you did not indicate which invoice payment was for.

    4. If you have not paid GAMP for these patients, request the invoice be credited for these patients.


    Why was I issued a credit memo?

    When you issue payment to WPS instead of GAMP on the Summary of the T19 Elgibile Claims
    Report     these amounts have an asterisk next to them.

    The Credit Memo amount is credited against the amount you owe in total because we do not know
    which specific invoice(s) are involved.

    Why did I receive a GAMP Statement?

    Periodically a statement is issued by GAMP, which shows all of your outstanding invoice balances.

    The names of the patients would have been sent to you with the invoices in previous months.

          If you have misplaced your backup, please indicate on the statement or open invoice report
    which invoices you need copies of and FAX to Sandra at (414) 289-6251. However,
    if you do not send a copy of the statement or open invoice report, please indicate your provider
    number and the specific invoice numbers for which you need back up.

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