The links below offer access to communications intended for Managed Care Organizations (MCOs) and key information and tools used most often.
General Information
- 1-2 Bed Adult Family Home Certification Standards
- Being a Full Partner booklet
- Capitation Rates
- DHS-MCO Contract
- Enrollment Data
- Family Care Fiscal Resources
- Integrated Employment and Prevocational Services
- Maps:
- Family Care Geographic Service Regions (PDF, 251 KB)
- Partnership/PACE Geographic Service Regions (PDF, 223 KB)
- MCO Contact Information (PDF, 72 KB)
- Notice of Action (NOA) and Notice of Denial Forms
- Nursing Home Resources in the Family Care Benefit
- Relocation Manual
- Restrictive Measures Forms:
Communications to MCOs
Family Care Technical Assistance and Resource Series
Training and Technical Assistance for Care Managers
- Self-Directed Supports in Family Care and Partnership: A Best Practice Guide for IDT Staff (PDF, 1.2 MB)
- Guidelines for Registered Nurse Delegation to Unlicensed Assistive Personnel (PDF, 208 KB)
- Webcast: Instructions for Standardizing Member Income Considered Available for Room and Board March 10, 2010; 52 minutes
- PowerPoint Handouts (PDF, 109 KB)
- Frequently Asked Questions | Submit a question
Third Party Administration (TPA) Claims Processing Services
In July 2009, the Department issued an RFP to contract for the services of a TPA to perform claims processing, encounter reporting, and other claims processing related services for Family Care and Family Care Partnership MCOs. In February 2010, the Department entered into a contract with two vendors, Vestica Healthcare, LLC, and Wisconsin Physicians Service Insurance Corporation (WPS). MCOs and the vendor will 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 (Exit DHS)
- RFP # 1677-DLTC-PM (PDF, 1.2 MB; issued July 2009)
- Final Claims RFP Master Agreement Template (PDF, 141 KB)
- Memo re: Partnership Pricing and Participating Agreement Template (PDF, 39 KB; 9/7/11)
- Participating Agreement Template for use by MCOs and TPAs (PDF, 58 KB)
- Participating Agreement Supporting Documents:
- Implementation/Transition Plan Standards (PDF, 21 KB)
- Communication Plan Protocols (PDF, 12 KB)
- Minimum Communication Requirements spreadsheet (Excel, 36 KB)
- Test Plan Standards (PDF, 21 KB)
- TPA Training and Technical Assistance Plan (PDF, 22 KB)
Request for Proposals/Information (RFP/RFI)
Managed Long Term Care Infrastructure Project (RFI # 1682-RFI-PM)
In August 2009, the Department issued an RFI to explore the potential for establishing a common system infrastructure that can support an array of Family Care, Family Care Partnership, PACE, and IRIS business and program operations in an integrated manner.
- RFI for LTC Managed Care Infrastructure Project (PDF, 186 KB)
- Appendix E (PDF, 29 KB)
- Appendix F (PDF, 19 KB)
Resources
- Encounter Reporting:
- Reference Materials (User guide, data dictionaries, content edits, etc.)
- Encounter Reporting Application
- ForwardHealth Portal
- Listserv signup pages:
