This page is intended for managed care organizations (MCOs) that operate the Family Care, Family Care Partnership, and PACE (Program of All-Inclusive Care for the Elderly) programs.
General information
Communications to MCOs
DHS-MCO contract and fiscal resources
Forms
- Notice of Adverse Benefit Determination (NOA) and Denial Letters
- Medical Remedial Expenses Checklist, F-00295 (Word)
- Restrictive Measures
Training and technical assistance for care managers
- Adult Long-Term Care Resource Catalog
- Long-Term Care: Worker Recruitment and Retention Resources
- Self-Directed Supports in Family Care, Partnership, and PACE: A Best Practice Manual for IDT Staff, P-00593 (PDF)
- Transition of Care Between Medicaid Programs or Between Agencies Within a Medicaid Program, P-02364 (PDF)
Third party administration (TPA) claims processing services
DHS contracts with Wisconsin Physicians Service Insurance Corporation for third party administration (TPA) services for Family Care MCOs. Services include claims processing, encounter reporting, and other claims processing related services, and the contract period runs through February 25, 2019. MCOs and the vendors are to use the following templates and supporting materials to document the terms and services of the contract.
- Online Statewide Long-Term Care Infrastructure Third Party Administration Contract
- RFP # 1677-DLTC-PM (PDF)
- Final Claims RFP Master Agreement Template (PDF)
- Amendment to TPA Contract (PDF)
- Memo re: Partnership Pricing and Participating Agreement Template (PDF)
- Participating Agreement Template for use by MCOs and TPAs (PDF)
- Participating Agreement Supporting Documents:
Other resources
- Encounter Reporting:
- Reference Materials (User guide, data dictionaries, content edits, etc.)
- Encounter Reporting Application
- ForwardHealth Portal
- Adult Long Term Care Functional Screen
- DHS memos library
- Sign up to receive email updates about DHS programs and services
- DHS video library
Last Revised: March 7, 2019
