Wisconsin ForwardHealth Updates — June 2008

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• 2008-38 — Additional ForwardHealth interChange Training Sessions Available in August 2008
• 2008-41 — Changes to Patient Liability for Hospice, Inpatient Hospitals, and Nursing Home Providers
• 2008-42 — Changes to STAT-PA for Retail Pharmacy Drugs
• 2008-43 — Reimbursement Policy Changes and Revision of Forms and Instructions for Nurse Aide Training/Testing and Preadmission Screening and Resident Review Level 1 Screening
• 2008-45 — Paper Claim Form Preparation and Data Alignment Requirements for ForwardHealth interChange
• 2008-93 — ForwardHealth Requires Providers to Use the 1500 Health Insurance Claim Form (version dated 08/05) or the UB-04 Claim Form

ForwardHealth Announces Changes to Paper and Electronic Claims Submission

The following ForwardHealth Updates introduce changes to paper and electronic claims submission for Wisconsin Medicaid and BadgerCare Plus providers. These changes are effective October 2008, with the implementation of the ForwardHealth interChange system and the adoption of National Provider Identifiers.

A separate Update will give providers a calendar of important dates related to implementation.

More service-specific Updates for providers will be published soon. Providers may check the ForwardHealth Web site at dhs.wisconsin.gov/ForwardHealth/ for updates that may have been released recently.

• 2008-46 —Ambulatory Surgery Center Services
• 2008-47 — Crisis Intervention Services
• 2008-48 — Community Support Programs
• 2008-50 — Outpatient Mental Health and Substance Abuse Treatment Services in the Home or Community for Adults
• 2008-51 — In-Home Mental Health and Substance Abuse Treatment Services for Children, A HealthCheck “Other Services”
• 2008-53 — Outpatient Mental Health Services
• 2008-55 — Outpatient Substance Abuse Treatment Services
• 2008-58 — Physical Therapy, Occupational Therapy, and Speech and Language Pathology Services
• 2008-59 — Adult Mental Health Day Treatment Services
• 2008-61 — Child/Adolescent Day Treatment Services, A HealthCheck “Other Services”
• 2008-63 — Nurse Midwife Services
• 2008-64 — Physician Services
• 2008-66 — Substance Abuse Day Treatment Services
• 2008-69 — Durable Medical Equipment
• 2008-71 — Disposable Medical Supplies
• 2008-73 — Enteral Nutrition Products
• 2008-75 — Vision Services
• 2008-77 — Community Care Organizations
• 2008-78 — Home Health Services, Including Private Duty Nursing and Private Duty Nursing to Ventilator-Dependent Members
• 2008-79 — Private Duty Nursing and Private Duty Nursing to Ventilator-Dependent Members by Nurses in Independent Practice
• 2008-80 — Podiatry Services
• 2008-81 — Portable X-ray Services
• 2008-82 — Ambulance Services
• 2008-83 — Independent Laboratory Services
• 2008-84 — School-Based Services
• 2008-85 — Specialized Medical Vehicle Providers
• 2008-86 — Prenatal Care Coordination Services
• 2008-87 — Case Management Services
• 2008-88 — Child Care Coordination Services
• 2008-89 — Chiropractic Services
• 2008-90 — End-Stage Renal Disease Services
• 2008-91 — Hearing Services and Hearing Instruments
• 2008-92 — Personal Care Services

Changes to Prior Authorization for Wisconsin Medicaid and BadgerCare Plus

The following ForwardHealth Updates introduce important changes to prior authorization (PA) for Wisconsin Medicaid and BadgerCare Plus services, effective October 2008, with the implementation of the ForwardHealth interChange system. These changes include the following:

• Establishing deadlines for providers to respond to returned PA requests and PA amendment requests.
• Revising all PA forms.

The changes were made to do the following:

• Provide efficiencies for both providers and ForwardHealth.
• Accommodate changes required for full National Provider Identifier implementation.
• Align with HIPAA terminology.

A separate Update will give providers a calendar of additional important dates related to implementation including when to begin submitting the revised PA forms.

More service-specific Updates for providers will be published soon. Providers may check the ForwardHealth Web site at dhs.wisconsin.gov/ForwardHealth/ for Updates that may have been released recently.

• 2008-49 — HealthCheck Services
• 2008-52 — In-Home Mental Health and Substance Abuse Treatment Services for Children, A HealthCheck “Other Services”
• 2008-54 — Outpatient Mental Health Benefit
• 2008-56 — Outpatient Substance Abuse Treatment Services
• 2008-57 — Pharmacy Services
• 2008-60 — Adult Mental Health Day Treatment Services
• 2008-62 — Child/Adolescent Day Treatment Services, A HealthCheck “Other Services”
• 2008-65 — Physician Services
• 2008-67 — Substance Abuse Day Treatment Services
• 2008-68 — Dental Services
• 2008-70 — Durable Medical Equipment
• 2008-72 — Disposable Medical Supplies
• 2008-74 — Enteral Nutrition Products
• 2008-76 — Vision Services