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Children’s Long-Term Support (CLTS) Provider Handbook

Section 10: Claims Process

Claims

The claims process is how CLTS Program providers request payment for approved services they have delivered. Providers submit claims through the ForwardHealth Portal. All CLTS Program providers must use their unique CLTS Provider Medicaid identification number (MA ID) or National Provider Identifier (NPI) to submit claims through the ForwardHealth Portal to an approved prior authorization. ForwardHealth has created other Children's Long-Term Support Program County Waiver Agency and Provider Resources.

Providers can submit a claim if:

  • The provider is enrolled as a Medicaid provider.
  • The provider is enrolled as a CLTS Program provider.
  • The service is covered by the CLTS Program.
  • The service is included in the ISP.
  • A prior authorization is approved and available on the ForwardHealth Portal.
  • The service was delivered exactly as authorized.

If not, a claim may be denied.

When submitting a claim, providers must enter accurate information, including the participant’s Medicaid information, provider and billing information, dates of service, and approved rate. The information provided must match the approved PA. You may need to split up larger files when you upload them.

Claim statuses

There are four claim statuses a provider may encounter:

Pay

  • For claims with a pay status, the paid date field indicates the date of the financial cycle to which the claim was assigned. This is also the date the payment was processed.
  • A paid date of 0 (or a blank paid date field) indicates that the claim has not yet been processed through a financial cycle. A paid date will be assigned when the claim completes processing.

Denied

  • These are claims in the ForwardHealth Portal that have been denied.
  • Under the claim status information, there will be an Explanation of Benefits (EOB) Information panel that shows the corrections that need to be made to the claim. Once those corrections are made, providers should use the Resubmit button at the bottom of the panel.

If a claim is denied, the provider should review the claim for:

  • The correct PA number.
  • Participant information.
  • The correct rate.

If the claim is denied after resubmission, the provider should reach out to cltsoperations@gainwelltechnologies.com for assistance.

Suspend

The claim is awaiting further review by ForwardHealth before a decision is made on how the claim will be processed: paid or denied.

Adjusted

On claims that involve an adjustment, the adjustment information panel will be displayed above the claim status information.

  • On the original claim, the adjustment information panel will display claim information from before and after the adjustment.
  • On the claim that was the result of an adjustment, the adjustment information panel will display the adjusted claim and original claim information.

Learn more about billings, claims, and payments by visiting the Trainings and Educational Resources in the ForwardHealth Portal.

Timely filing

ForwardHealth promptly pays for correct and complete original service claims that are filed within 365 days from the date of service. For CLTS participants whose services are covered by other primary insurance, the timely filing deadline is within 365 days from the carrier’s explanation of benefits statement date. Submitting claims regularly helps prevent timely filing issues and payment delays.

Electronic Funds Transfer (EFT) and payments

Providers can enroll in Electronic Funds Transfer (EFT) using the ForwardHealth Portal. It’s important to note that once enrolled in EFT, providers cannot revert to receiving paper checks. Refer to the user guide in ForwardHealth Communications to walk through setting up EFT.

Claims processed by 3 p.m. Central Standard Time (CST) on Friday will be paid the following Monday. For example: Claims processed by 3 p.m. on Friday, May 9, 2025, will be paid on Monday, May 12, 2025. Providers who have EFT will see the payment in their accounts by Thursday of the week of payment. Electronic versions of remittance advices (ERAs) are available by 10 a.m. CST on Mondays. Find instructions for locating ERAs in the ForwardHealth Provider Portal Remittance Advice User Guide, P-00961 (PDF).

Providers who do not enroll in EFT will have paper checks mailed to them by Tuesday of the week payment is made.

Glossary