The Department of Health Services (DHS) has contracted with a Third Party Administrator (TPA) claims vendor to process the Children's Long-Term Support (CLTS) Waivers provider service claims and collect appropriate claims report data, according to federal regulations. The selected TPA vendor is the Wisconsin Physicians Service (WPS).
County Waiver Agency Information
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See the following DLTC Memo for more information related to the Statewide TPA implementation:
See the following TPA provider forms:
- IRS W-9 Form Request for Taxpayer Identification Number and Certification (PDF)
- Third Party Administration (TPA) Children's Medicaid Waivers Provider Billing and Service Information (F-00412) (Word)
A Note Regarding ICD-10
Beginning on October 1, 2015, Wisconsin Physicians Service, the Department's third party administrator for the Children's Long-Term Supports (CLTS) Waivers claims processing, will accept only ICD-10 medical codes for any medical service claims submitted for payment after October 1, 2015. Provider claims submitted with ICD-9 codes after October 1, 2015, will not be accepted.
Non-medical providers using the ICD-9 default code of 780.99 can use the ICD-10 default code of R6889 when submitting electronically. Paper and spreadsheet claims can continue to be submitted without an ICD-10 code for non-medical services.
Additional details are available on the ForwardHealth ICD-10 Code Set Transition page.
For more information regarding the TPA claims processing, contact:
County Waiver Agencies:
DHS Children's Long-Term Supports Waiver:
WPS CLTS Customer Service Call Center, Monday through Friday at:
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WPS CLTS Customer Service Call Center Monday through Friday at: