The Best Medical Billing Company in Wisconsin - Shoreline
Shoreline Medical Billing company delivers certified billing, AR recovery, and 96% clean claim rates to healthcare providers across Wisconsin.
Comprehensive Medical Billing Services for Wisconsin Practices
Shoreline Medical Billing company is a proud Maine-based company that offers end to end revenue cycle management services to physicians and Medical billing companies in Wisconsin. Our goal is to help them manage their business in a way where they can focus on patient care and operations, not paperwork! By providing great services at reduced costs, we have been able to keep our customers since our inception in 2010. Explore our case studies to see how we’ve helped practices overcome complex billing challenges and improve cash flow.
As a medical billing outsourcing company, we have helped our clients grow their business by providing them with the resources they need to succeed while maintaining a competitive edge in today’s industry. We offer timesaving, cost-effective revenue cycle management services to your Wisconsin-based practice. Ready to outsource your billing needs? We’ll guide you through your receivable account to make sure that your claims are paid.
Best In The Industry
Shoreline Medical Billing company in Wisconsin exceeds customer expectations and we are proud of our history, but more importantly we are focused on the future. We have grown in recent years by continuing to invest in technology and people while maintaining a commitment to excellent service and innovation. We have the best customer service and one of the highest success rates for reimbursement, so you know your money will be going where it belongs - back into your pocket.
Wisconsin Healthcare Billing Challenges We Solve
Stabilize eligibility volatility with proactive verification
The state of Wisconsin have not yet expanded its Medicaid program under the ACA, which has resulted in frequent eligibility fluctuations, especially for adults near income thresholds. Patients often move in and out of eligibility within short timeframes creating higher rate of recoupments after payment. This instability forces providers to absorb unpaid services. We at Shoreline Medical Billing company have integrated the real-time eligibility checks on daily basis during appointment scheduling and at the point-of-care. We conduct patient financial counseling workflows to capture their liabilities and payment authorizations upfront. This helps organizations to have fewer retroactive denials and write-offs, with reduced patient-balance and improvement in the first-pass acceptance rate.
Automate BadgerCare Plus with Wisconsin specific configurations
The BadgerCare Plus program is divided into multiple benefit plan for children, parents/caretakers, pregnant women, childless adults, and certain waiver-based populations each with different coverage rules and service limitations. The same CPT code may be payable for one eligibility group but denied for another. This makes automated rules engines less reliable without Wisconsin-specific configuration. At Shoreline Medical Billing company we have Wisconsin-configured rules engine that maps CPT/HCPCS and modifiers to BadgerCare eligibility classes (children, parents, pregnant, waiver populations). This helps to reduce the category-based denials.
Protect the Reimbursement rate through specialty-aware coding
Specialties like behavioral health, pediatrics, and long-term care experiences lower reimbursement and have lesser chances for negotiation. Shoreline Medical Billing company have specialty coding teams who are well versed in Wisconsin specific fee schedules, bundling rules, and common denial triggers. Partnering with us organizations can improve their financial stability and reduce the revenue leakage.
Comprehensive Revenue Cycle Management Services for Wisconsin
Specialized Services tailored to meet Wisconsin's Medicaid rules and regulations
Managed Care vs. FFS Claim Routing
Automated payer-ID resolution to correctly route claims to Wisconsin MCOs or Medicaid FFS
Eligibility & Coverage Verification
Real-time BadgerCare Plus eligibility checks at scheduling and date-of-service and retro-eligibility monitoring
Charge Capture Management
Audits encounter documentation to ensure all billable services are captured.
Timely Filing Management
Tracks filing and rebilling deadlines for original, corrected, and appeal claims
Denial Management
AI based tools to track and flag denial codes and root-cause analysis tailored for Medicaid claim categories, identifies high-risk categories and automate resubmissions.
Patient Statements & Follow-Up
Communicate with patients and give Explanation of Benefits (EOBs). Includes text/email payment reminders and online payment options.
Wisconsin Medical Billing Knowledge Hub
Essential regulatory benchmarks, payer policies, and billing guidelines for healthcare practitioners in Wisconsin.
Wisconsin Medicaid Filing Windows
Claims for Wisconsin Medicaid must be submitted within 365 days ForwardHealth / 90-180 days HMOs from date of service. Claims exceeding this window are permanently denied unless accompanied by documented proof of timely filing with another primary payer.
Statutory Pay Protection
Under State statutory prompt payment laws (Wis. Stat. § 628.46 (30 days)) with strict interest penalty enforcement, commercial insurers and HMOs must settle clean claims on time. Delayed claims trigger statutory interest penalties that our recovery team collects on your behalf.
Wisconsin State Provider Portal & MMIS Connectivity
We maintain direct EDI connections for electronic claim submission, real-time eligibility inquiry, and rapid electronic remittance advice posting.
Serving Healthcare Providers Across Wisconsin
From Ashland to Washburn, we provide comprehensive medical billing services across all 72 Wisconsin Counties.
Northern Wisconsin
Ashland, Barron, Bayfield, Burnett, Douglas, Florence, Forest, Iron, Langlade, Lincoln, Oneida, Polk, Price, Rusk, Sawyer, Taylor, Vilas, Washburn.
Northeast Wisconsin
Brown, Calumet, Door, Fond du Lac, Green Lake, Kewaunee, Manitowoc, Marinette, Marquette, Menominee, Oconto, Outagamie, Shawano, Sheboygan, Waupaca, Waushara, Winnebago.
West Central Wisconsin
Adams, Buffalo, Chippewa, Clark, Crawford, Dunn, Eau Claire, Jackson, Juneau, La Crosse, Marathon, Monroe, Pepin, Pierce, Portage, St. Croix, Trempealeau, Vernon, Wood.
South Central Wisconsin
Columbia, Dane, Dodge, Grant, Green, Iowa, Lafayette, Richland, Rock, Sauk.
Southeast Wisconsin
Jefferson, Kenosha, Milwaukee, Ozaukee, Racine, Walworth, Washington, Waukesha.
Wisconsin Medical Billing Glossary
Key regulatory terms and definitions essential for compliant medical billing in Wisconsin.
BadgerCare Plus
Wisconsin’s Medicaid and CHIP program that delivers healthcare coverage to eligible low-income children, parents and caretakers, pregnant individuals, and certain adults who do not have dependent children.
BadgerCare Plus
Wisconsin’s Medicaid and CHIP program that delivers healthcare coverage to eligible low-income children, parents and caretakers, pregnant individuals, and certain adults who do not have dependent children.
Coordinated Specialty Care (CSC)
It is a treatment model with a multidisciplinary team for providing support to young adults who are experiencing early psychosis or other serious mental health conditions.
ForwardHealth
It is the healthcare program administered by the Wisconsin Department of Health Services to manage all the operations of Medicaid, BadgerCare Plus, and other health initiatives for the state.
