Section 9: How to Bill for Services

ForwardHealth Portal

The ForwardHealth Portal is a website for Wisconsin Medicaid providers. It has public pages with helpful resources. Providers can also log into the to the ForwardHealth Portal to:

Submit and track claims.
Check claims status and payment information.
View prior authorizations (PAs).
Access messages and updates related to ForwardHealth.

Welcome and PIN letters

As a new CLTS Program provider, you will get two letters 5–7 business days after completing your CLTS provider enrollment with DHS in the CLTS Provider Registry:

A welcome letter with your CLTS-specific Medicaid ID number (provider ID)
A PIN letter with a PIN you will use to log into the ForwardHealth Portal

Prior authorizations (PAs)

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

Providers must verify participant enrollment in the ForwardHealth Portal prior to each time a service is rendered. If a service is rendered to a participant during a time that participant is not enrolled, the provider will not be paid for that claim.

Providers should reach out to SSCs if they have questions or concerns regarding how long it will take for a prior authorization to be issued.

How to look up a prior authorization in the ForwardHealth Portal

The ForwardHealth Portal contains step-by-step guides for providers on a variety of topics, including Prior Authorization. Visit Trainings and Educational Resources for detailed instructions.

Issue resolution for prior authorizations

PAs are required for CLTS Program services. Services should not be provided until the PA is approved. Sometimes, issues come up during the PA process. Some common PA issues providers may experience include:

A PA denial.
A PA delay.
The approved service not matching what was requested in the PA.
Services provided without an approved PA.

When a PA issue occurs, a provider should:

Review the PA decision carefully.
- Check if the status is approved or denied.
- Look for notes explaining the decision.
Confirm service plan details.
- Confirm the service amount, start dates, and provider information.
Contact the participant’s support and service coordinator.
- Share specific details about the issue.

Appeals and disagreements

Providers do not file appeals on behalf of families. If a family disagrees with a PA decision, a provider should inform the family of their right to appeal, refer the family to their SSC for appeal information and support, and continue providing only approved services during the appeal process. Find more information on Participant Rights and Responsibilities Notification, F-20985.

Participant eligibility

Verify participants’ Medicaid eligibility before delivering services. Only children who are eligible for Wisconsin Medicaid can join and stay enrolled in the CLTS Program. When participants lose their Medicaid eligibility, they are disenrolled from the CLTS Program. As a CLTS Program provider, this might affect your ability to get paid. If a participant isn’t eligible for Medicaid at the time you deliver a service, your claim will be denied.

You can check a participant’s Medicaid eligibility using the ForwardHealth Portal. The Enrollment Verification User Guide explains how. Here are the basics.

Go to the ForwardHealth Portal.
Log in.
Select Enrollment on the main menu at the top of the page.
Enter the required participant information and the time period you delivered services and select Search.
Confirm the participant has “Medicaid” listed under Benefit Plan, and that the Effective Date and End Date includes your date of service.

For more detailed information, visit the ForwardHealth Portal Enrollment Verification User Guide, P-00955 (PDF).

Benefit Code Crosswalk

The Benefit Code Crosswalk, P-02283 (PDF) offers detailed information about the specific codes used for services. The Benefit Code crosswalk helps ensure that approved services align with the correct benefit codes used for prior authorizations and billing.

Some CLTS benefit categories and sub-categories are not included under the DHS established rates because they are paid at market rates (for example, housing support services, personal emergency response system, and respite camps).

CLTS Program rate schedule

The Children's Long-Term Support (CLTS) Waiver Program Rate Schedule, P-02184, lists the set rates the CLTS Program will pay for authorized services. The rate schedule lists the highest amount the CLTS Program will pay for each listed service. Providers bill up to their usual and customary rate and agree to accept no more than the rate schedule for CLTS participants. The CLTS Waiver Program Rate Schedule primarily sets rates for services that have a direct care provider component.

Services paid at a market rate

CLTS services that are not listed on the Rate Schedule are paid at a market rate. Market rates are the provider’s usual and customary costs – the rate the provider charges to the public. Usual and customary or market rate amounts should be publicly available and not more than the rate the provider charges other customers.

Prohibited balance billing

If you are a CLTS provider, and a service is covered by the CLTS Program and approved in the participant’s ISP and PA, you may not bill the family beyond the amount paid by the CLTS program. The CLTS Program rate is considered payment in full for that covered service.

CLTS Provider Relations inbox

For assistance setting up and managing information in the ForwardHealth Portal or other technical assistance, contact CLTS Provider Relations at dhscltsproviderrelations@dhs.wisconsin.gov.