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Children's Long-Term Support: Information on Prior Authorizations and Claims Submission for County Waiver Agencies

The Children's Long-Term Support (CLTS) Program uses the ForwardHealth Portal for all prior authorizations and claims processing.

If you have any questions on the transition to ForwardHealth, please contact the CLTS Operations Team at cltsoperations@gainwelltechnologies.com or 844-942-5870.

Claims processing information for providers

Prior authorization

County waiver agencies (CWAs) must submit prior authorizations to the ForwardHealth Portal for all services funded through the CLTS Program. A prior authorization (PA) is required before a CLTS Program provider delivers a service and submits a claim for payment.

CWAs have two methods for submitting PAs to the ForwardHealth Portal:

  1. Direct data entry via the ForwardHealth Portal (this is a one-at-a-time entry and offers real-time validation of the PA)
  2. Flat file upload via the ForwardHealth Portal (CWAs must use the state-approved PA file format)

Diagnosis codes and provider Medicaid IDs must be included on all PAs.

CWAs may amend PAs through direct data entry or flat file upload. Amending PAs requires the CWA to use the ForwardHealth PA number for matching purposes.

Claim submission

All CLTS Program providers must use their unique CLTS Provider Medicaid ID to submit claims through the ForwardHealth Portal to an approved prior authorization.

CLTS Program providers have several methods for submitting claims to the ForwardHealth Portal:

  • Direct Data Entry—allows providers to directly enter a claim into the ForwardHealth Portal
  • Copy a Claim—the ForwardHealth Portal saves claim information and allows providers to copy a claim, in a paid status, to a new claim for easy editing before submitting it as a new claim
  • Create a Claim from a PA—allows providers to create a claim based on information from the PA, with information prepopulated on the claim
  • Electronic Data Interchange (EDI): 837 Health Care Claim transactions
    • 837 transactions will continue to be accepted
    • The ForwardHealth Portal webpage has companion guides to support 837 transactions
  • 1500 Health Insurance Claim Form and UB-04 Claim Form—providers can mail in paper claim forms

Resources

ForwardHealth CLTS Program CWA and Provider Resources

The webpage includes, but is not limited to, resources on the following topics:

  • User Guides for the Waiver Agency Portal, submitting PAs, and Professional Claims
  • Training videos on using the Portal for both PAs and Claims, and how to view remittance advices
  • Factsheets on place of service codes
  • Electronic Data Interchange guidance
  • Creating a PA Bulk Report
  • A PA Error Checklist
  • Multiple Dates of Service on a Claim guidance

TPA events and communications

More events coming soon!

Demonstration sessions

August 13 and 15, 2024, How to Submit an 837 Demonstration
July 24 and 25, 2024, Portal and Claims Submission Demonstration Sessions

Forums

May 20, 2025
April 9, 2025
  • Agenda: Project timeline, implementation dates, eligibility validation for PAs and claims, CWA claims limitations, code crosswalk, place of service codes, ForwardHealth Portal overview, Submission Sandbox, finding Medicaid IDs (MA IDs), outstanding checks and recovery
  • Apr. 9, 2025, recording
  • Apr. 9, 2025, presentation (PDF)
March 6, 2025
  • Agenda: Project timeline, implementation dates, ForwardHealth Portal, PAs, Submission Sandbox testing, county waiver agency (CWA) TPA transition, webpage: what’s new?, Gainwell CLTS Operations Team, training opportunities
  • Mar. 6, 2025, recording
  • Mar. 6, 2025, presentation (PDF)
December 12, 2024
  • Agenda: Project timeline, webpage, Gainwell Operations Team introduction, Medicaid IDs and National Provider Indicators, testing process and submission sandbox, prior authorization number on claims, Waiver Agency Portal Guide, International Classification of Diseases, Tenth Revision (ICD-10) codes on Wisconsin Physicians Service (WPS) transfer prior authorizations, date span billing, claim adjustments, discussion, what’s next
  • Dec. 12, 2024, recording
  • Dec. 12, 2024, presentation (PDF)
October 16, 2024, CLTS TPA Transition
  • Agenda: Project timeline, webpage, ForwardHealth CWA user roles, date span billing, Medicaid IDs, ending PAs, prior authorization uploads, payment schedules and remittance advice (RA) schedules, support and service coordinator (SSC) case management rates, financial management services (FMS)
  • Oct. 16, 2024, recording
  • Oct. 16, 2024, presentation (PDF)
August 7, 2024, CLTS TPA Transition
May 15, 2024, CLTS TPA Transition
February 21, 2024, CLTS TPA Transition
December 19, 2023, CLTS Program TPA Transition
October 26, 2023, CLTS Program TPA Transition
Prior authorization training and claims training

The presentations and recordings from the February training can be found on the ForwardHealth website under "Training Resources for the Submission Sandbox."

Glossary

 
Last revised September 2, 2025