Submitting Claims on Converted Prior Authorizations

The Wisconsin Department of Health Services (DHS) is providing Children's Long-Term Support (CLTS) providers with information to understand prior authorizations (PAs) converted from WPS in the ForwardHealth Portal. The CLTS Operations Team has determined that more guidance is needed to help CLTS providers understand converted PA dollars and units. This will help ensure claims are processed in the portal appropriately.

All PAs that were converted from WPS to the ForwardHealth Portal begin with 999. Converted PAs can be found by searching in the portal or running a Bulk PA Report. See the April 30 Finding Prior Authorization Numbers message for instructions on how to run a Bulk PA report.

Converted PAs that only have dollars with zero units

This type of PA will pay up to the dollar amount billed, until all dollars on the authorization have been paid. CLTS providers may bill as many units as necessary. Note: claims must always indicate at least one unit, despite the PA showing zero units.

Converted PAs that only have units with zero dollars

This type of PA will pay the number of units and dollars billed up to the maximum rate shown on the CLTS Statewide Uniform Rate Schedule. The claim will pay until all units have been used. Note: claims must always indicate a dollar amount billed, despite the PA showing zero dollars.

Converted PAs that have both units and dollars

This type of PA will pay each unit billed with a maximum dollar amount per unit according to the PA. The claim will pay until all units have been used. Note: claims must always indicate a number of units and a dollar amount billed.

Learn more about submitting claims

For more information on how to correctly enter claims in the ForwardHealth portal, see the May 23 ForwardHealth Claim Information message.

Have questions or need help?

If you have questions or need help, please contact the CLTS Operations Team at cltsoperations@gainwelltechnologies.com or 844-942-5870.