Children's Long-Term Support: How do providers get paid?

Steps to get paid

Step 1

Before you deliver a service, make sure you have a prior authorization (PA) from the county waiver agency (CWA) of the county the participant lives in.

The PA will have the service, rate, and frequency that is approved for the child. Once you have a PA from the CWA, you may deliver the service.

Step 2

After delivering the authorized service to the Children's Long-Term Support (CLTS) Program participant, you will submit a claim for that service.

Claims processor update

You can begin submitting claims with Gainwell Technologies, the new CLTS claims processor, in the ForwardHealth Portal on April 28, 2025. Your claims will be processed on May 5, 2025.

For information about the new claims processor for the CLTS program visit the ForwardHealth CLTS Transition webpage.

The ForwardHealth Portal offers a few streamlined ways to submit claims.

• Direct data entry: you can enter a new claim right into the portal.
• Copy a claim: the portal allows you to copy information from a paid claim to a new claim. You can then make any needed edits before submitting your new claim.
• Create a claim from a prior authorization: you can create a claim using a PA. It will prepopulate information on the claim based on the PA.

You can submit claims for dates of services before the transition date. You have 365 days from when the service happened to submit a claim.

Step 3

Know how you’ll get paid. You can get paid in one of two ways:

• Electronic funds transfers (EFT), which is a direct deposit to a
  bank account of your choosing
• Paper check in the mail

If you want to get paid via EFT, you’ll have to sign up for EFT in the ForwardHealth Portal. EFT information from WPS does not carry over. Only a clerk from your organization who has been assigned the EFT role can sign up for EFT. Once you sign up for EFT, you cannot revert to receiving paper checks.

You can change your EFT information at any time. Signing up for EFT does not change your Remittance Advice.

 Third Party Administrator (TPA) Update

The claims processor for the CLTS Program will transition from WPS Physicians Service (WPS) to Gainwell Technologies, LLC. (GWT). The anticipated date of this transition is May 5, 2025. This page provides information on the current processes through WPS.

TPA Transition Information for Providers