5 Payments

Note: Payments will not be approved or issued if the good(s) or service(s) have not been provided.

5.1 Denying or Reducing Payments

WFCAP payments can be denied and/or reduced for reasons including, but not limited to the following:

The application for payment was not submitted on the proper form.
The decedent does not qualify for WFCAP benefits.
The decedent information is incomplete.
The application was received more than one year after the confirmed date of death.
The date of service is a future date.
A date of service for each category of payment being requested was not provided.
The service provider’s information is incomplete.
The application was submitted by an entity other than a funeral home, cemetery, or crematory.
Payment for funeral expenses was requested, but the signed Final Itemized Funeral Home Billing Statement with Payment Sources was not submitted.
Payment for cemetery/crematory expenses was requested, but the signed Itemized Cemetery and/or Crematory Statement with Payment Sources was not submitted.
Total funeral expenses are unclear.
Total cemetery/crematory expenses are unclear.
Total funeral expenses exceed the cap of $4,500 and no special circumstances are indicated.
Total cemetery/crematory expenses exceed the cap of $3,500.
A burial plot was not accounted for on the Final Itemized Cemetery Statement with Payment Sources.
Special circumstances were requested, however, verifying documentation was not provided.
Special circumstances were requested, however, upon review, the special circumstances were not approved.
Payment for funeral expenses was requested, however, the funeral home service provider and/or the executor or family representative has not signed and dated the form.
Payment for cemetery and/or crematory expenses was requested, however, the cemetery and/or crematory service provider and/or the executor or family representative has not signed and dated the form.
There is a life insurance policy insuring the decedent’s life, however, adequate verifying documentation was not submitted.
The life insurance declaration section of the application was not signed and dated by both the service provider and the executor or family representative.
There is a life insurance policy insuring the decedent’s life, therefore, payment has been reduced by one dollar for every dollar by which the death benefit of the policy exceeds $3,000.
The Final Itemized Funeral Home Billing Statement with Payment Sources indicates that the total expenses on the application include fees for services rendered by a coroner or medical examiner, fees assessed for the signing of a death certificate by a coroner or medical examiner, and/or fees assessed by a county related to transportation services.
The funeral home and crematory have the same Tax ID number.
The total funeral payment request exceeds $1,500.
The total cemetery/crematory payment request exceeds $1,000.
The executor or family representative information is incomplete in Section 9.
New signatures and dates from the provider and/or executor or family representative were requested, but were not provided.
There was no response to the Verification Checklist within 15 calendar days.

If the reason for denial is for incomplete or insufficient information, or lack of verifying documentation, service providers will be sent a WFCAP Verification Checklist. This notice will identify any missing items or documents and the service provider will be given 15 calendar days to submit the requested items or documents. If the requested items or documents are not received by WFCAP by the stated due date, the application will then be denied.

Note: Providers will have 10 calendar days from the date of the denial to resubmit the requested verification items. After the 10th calendar day, an entirely new application will be due, including new signatures and dates from the service provider(s) and the executor or family representative.

5.2 Payment Summary

A Payment Summary will be mailed or emailed to the executor or family representative upon final review of the WFCAP application. The Payment Summary will inform the executor or family representative of the total reported expenses, payments, payment amount(s) applied for, approved or denied payment amount(s), and if denied, the WFCAP reason for denial.

Note: Only providers have appeal rights. Family members do not have appeal rights.

5.3 Discretion in Approving Payments

Prior authorization is not required (such as approval prior to the funeral) as a condition of payment or that the services of a particular funeral home, cemetery and/or crematory association be used.

There is no requirement that a funeral home, cemetery, or crematory bill for expenses at a wholesale amount, including those for outer burial containers, vaults, or urns. The funeral home, cemetery, or crematory may bill wholesale or retail for expenses. Regardless of the choice, the total expense caps will apply subject to the policies documented here.

5.4 Required Forms for Payments

In order to receive WFCAP payments, the following forms must be on file with the DHS Department of Health Services Division of Enterprise Services for each funeral home, cemetery, or crematory:

Form W-9, Request for Taxpayer Identification Number and Certification
DOA-6460: New Supplier Form. This is the form any supplier needs to complete in order to receive payment. This form should always be submitted with a W-9 and Bank Verification.
DOA-6456: Authorization for Direct Deposit. This form is meant to add or update automatic clearing house (ACH) or direct deposit information for existing suppliers. Required bank verification: a copy of a current voided check or a bank letter on bank letterhead, signed by a bank representative. Each must include the individual or company name, routing, and account numbers.
DOA-6457: Existing Supplier Address Change/Update Form. This form is intended for existing suppliers to request changes to their current location(s), such as a change in address or addition of new location.
DOA-6458: Change of Supplier Name. This form is intended for when a business or individual has a legal name change. This includes part of a name being removed, a name being added, or a change to a new name altogether.

Note: Copies of the required forms listed above can be obtained by emailing DHSDLDESBFSVendorVAL@dhs.wi.gov or by contacting WFCAP.

The above forms should be completed and emailed to DHSDLDESBFSVendorVAL@dhs.wi.gov, or faxed to 608-710-6712. If service providers have questions the forms, they should contact the Division of Enterprise Services, Bureau of Fiscal Services, by email at DHSDLDESBFSVendorVAL@dhs.wi.gov.

This page last updated in Release Number: 22-01

Release Date: 05/02/2022

Effective Date: 05/02/2022