Group Health Cooperative of South Central Wisconsin

Group Health Cooperative of South Central Wisconsin was paid $270K by Medicaid between Jan 2018 and Nov 2023, across 32 billing codes. Its largest line is 99214, doctor's office visit, returning patient (more involved) — 46% of everything it billed.

33Billing provider infoGROUP HEALTH COOPERATIVE OF SOUTH CENTRAL WISCONSIN
MADISON, WI 53717

33aNPI1245260165assigned 07/04/2006

33bProvider typeHealth Maintenance Organization

28Total paid$270K

24GClaims13,078

24DCodes billed32

24AFirst – last monthJan 2018 – Nov 2023

Compared with peers

Next to other Health Maintenance Organization providers in Wisconsin

Rank by total paid#6 of 10

Median peer was paid$270K

This provider vs. median1.0×

Peers share this provider's primary NPPES type and state. Size alone says nothing about billing quality: a big agency or a hospital system is expected to sit far above the median.

Box 24A · Dates of service

Paid by month

Paid that monthNov–Dec 2024: claims still arriving when the file was cut, so these months run low for every provider

By year, as a table

Year	Claims	Paid
2018	6,798	$134K
2019	4,765	$107K
2020	1,320	$26K
2021	140	$1K
2022	14	$245.69
2023	41	$704.04

Box 24 · Service lines

What it billed for

Code	Service	Share	Claims	Bene. records	Paid
99214	Doctor's office visit, returning patient (more involved)Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity	46%	2,932	2,742	$123K
99213	Doctor's office visit, returning patient (routine)Office or other outpatient visit for the evaluation and management of an established patient, low complexity	34%	3,619	3,333	$92K
90688		5.2%	580	568	$14K
90686		3.2%	338	335	$9K
92015	Determination of refractive state	2.8%	798	769	$7K
90834	Psychotherapy session, about 45 minutesPsychotherapy, 45 minutes with patient	1.5%	72	53	$4K
99000		1.3%	920	814	$4K
85025	Blood count; complete (CBC), automated, and automated differential WBC count	1.3%	357	309	$3K
92004	Ophthalmological services: medical examination and evaluation, comprehensive, new patient	1.0%	65	65	$3K
99393	Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years)	<1%	31	28	$2K
92014	Ophthalmological services: medical examination and evaluation, comprehensive, established patient	<1%	40	38	$2K
99443		<1%	55	48	$1K

20 more codes

90672		<1%	22	$792.00
99391	Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year)	<1%	13	$747.89
98941	Chiropractic manipulative treatment; spinal, 3-4 regions	<1%	41	$704.04
90792	Psychiatric diagnostic evaluation with medical services	<1%	17	$615.16
87880	Infectious agent antigen detection by immunoassay; Streptococcus, group A	<1%	27	$453.14
99442		<1%	37	$450.86
98940		<1%	27	$433.97
90832	Psychotherapy session, about 30 minutes	<1%	13	$432.44
0001A		<1%	12	$419.76
84460		<1%	42	$295.89
0011A		<1%	17	$287.98
80048	Basic metabolic panel (calcium, ionized)	<1%	13	$137.97
87081		<1%	12	$109.70
36415	Collection of venous blood by venipuncture	<1%	1,420	$8.70
90471	Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine	0%	1,339	$0.00
97802		0%	57	$0.00
90472	Immunization administration, each additional vaccine (list separately)	0%	95	$0.00
97803		0%	25	$0.00
90473		0%	22	$0.00
98968		0%	20	$0.00

Claims and beneficiary counts add up across code × month rows, so one patient seen every month counts many times. Rows with fewer than 12 claims are suppressed by HHS, so small lines can be missing.

From NPPES

Who's on the registration

Authorized officialQUADE, BRUCE (CFO)