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Children’s Long-Term Support: HealthCheck Information for Counties

County waiver agencies are an important connection to HealthCheck for families in the Children’s Long-Term Support (CLTS) Waiver Program. County waiver agency staff tell families about HealthCheck, how it works, and how to access it.

Watch the provider video for an overview of HealthCheck.

 

 

HealthCheck FAQs (frequently asked questions)

Learn more about HealthCheck from this list of FAQs.

HealthCheck is the Wisconsin Medicaid term for the federal Early and Periodic Screening, Diagnosis, and Treatment benefit. The law requires state Medicaid programs to offer preventive services for Medicaid members under age 21. The goal of HealthCheck is to prevent illness and find and treat health issues early.

View Introduction to HealthCheck and HealthCheck “Other Services,” P-02413 (PDF).

HealthCheck covers most diagnostic and intervention services. The benefit offers periodic, full health screening exams. We call these “well-child checks.” Well-child checks include:

  • Dental checks.
  • Growth and development checks.
  • Head-to-toe physical exams.
  • Health information.
  • Hearing and vision checks.
  • Immunizations.
  • Lab tests.
  • Nutrition checks.

Wisconsin Medicaid follows the Recommendations for Preventive Pediatric Health Care (PDF) from the American Academy of Pediatrics. The chart shows when to schedule wellness tests and procedures.

In addition to well-child checks, HealthCheck covers:

  • Extra medical health needs, known as “Other Services.”
  • Interperiodic screens.
  • Outreach and case management.

Families use their ForwardHealth card to access HealthCheck services. ForwardHealth includes:

The law makes states cover health care services beyond well-child checks when a patient needs them to prevent, correct, improve, or maintain a physical or mental condition. Wisconsin calls this requirement “Other Services.”

“Other Services” may include:

  • Dental care.
  • Physician services.
  • Home health services.
  • Medical equipment and supplies.

View the HealthCheck Online Handbook: Covered Services and Requirements. Helpful chapters include:

  • Covered Services and Requirements.
  • HealthCheck “Other Services.”
  • Prior Authorization.

Providers must submit a prior authorization request before offering “Other Services.” There are two ways to fill out the Prior Authorization Form (PA/RF), F-11018:

  • Prior authorization for exceptions to coverage limitations
  • Prior authorization for services not routinely covered

Each way has different requirements. See the ForwardHealth Online Handbook, Prior Authorization for HealthCheck “Other Services.”

If you’ve asked for prior authorization in the past, you may notice some changes. We’ve worked to ease the process. We want to make sure people can get “Other Services” when they need them.

Key changes include:

  • There are fewer steps.
  • You don’t need “pink cards” or other special forms from the provider for people under 21.
  • Providers only need to submit one prior authorization request. The result of the request is final.

Some providers get their prior authorization request back. This doesn’t mean it is denied. Often, a return means the request needs more details. You must re-submit the updated request. Make sure you include the right information.

You can use these program contacts. You also can refer providers to them.

  • Provider Services Call Center: 800-947-9627. They help with questions about:
    • Billing.
    • Coverage policy.
    • HealthCheck enrollment.
  • Provider Relations Representatives. They help:
    • Answer more complex questions than Provider Services.
    • Answer questions about coverage policy.
    • Find Medicaid providers.
  • Bureau of Children's Services (BCS) Technical Assistance Center at DHSBCSTAC@dhs.wisconsin.gov or 608-267-6767. They can explain how the Children’s Long-Term Support Waiver Program and ForwardHealth intersect.
  • ForwardHealth Member Services: 800-362-3002. They support families.

Related topics

The information on this web page is in line with Wis. Admin. Code §DHS 107.22 Early and Periodic Screening, Diagnosis, and Treatment services.

Last revised September 5, 2023