ForwardHealth interChange

The Department of Health and Family Services (DHFS) will replace the existing Medicaid Management Information System, Wisconsin Medicaid’s claims processing system, in October 2008 by implementing ForwardHealth interChange. This new system is supported by the state’s fiscal agent, EDS, based on a tested and federally certified system that is already operating in several other states.

ForwardHealth interChange will support multiple state health care programs and Web services, including:

• BadgerCare Plus.
• BadgerCare Plus and Medicaid managed care programs, including:
  • BadgerCare Plus HMOs and Medicaid SSI HMOs.
  • Children Come First.
  • Family Care.
  • Program of All-Inclusive Care for the Elderly.
  • Wisconsin Partnership Program.
  • Wraparound Milwaukee.
• SeniorCare.
• Wisconsin Chronic Disease Program.
• Wisconsin Immunization Registry.
• Wisconsin Medicaid.
• Wisconsin Well Woman Medicaid.
• Wisconsin Well Woman Program.

Both public and secure information will be accessible via computer through a single point of entry called a Web portal. Public information is accessible to all users; however, to gain access to secure information and to exchange electronic transactions with the DHFS, providers and trading partners will be required to establish secure accounts within the ForwardHealth Portal. Trading partners will be the first to begin establishing Portal accounts, followed by providers. By establishing an account, providers and trading partners may fully utilize the benefits of the new system.

Note: A “trading partner” is defined as a covered entity that exchanges electronic transactions as mandated by the Health Insurance Portability and Accountability Act of 1996. Examples of DHFS trading partners include state-contracted managed care programs, billing providers who exchange electronic transactions directly with the DHFS, and billing services and clearinghouses that exchange electronic transactions directly with the DHFS on behalf of a billing provider.

Benefits of the Portal

The Portal will allow providers and trading partners to exchange electronic transactions through a secure entry point 24 hours a day, seven days a week. After creating an account for the Portal, providers may do the following:

• Submit individual electronic claims and adjustments and receive real-time responses. This includes making corrections and resubmitting claims.
• Submit electronic prior authorization (PA) requests, including attachments, and request amendments to PA requests electronically for all services requiring PA.
• Verify member enrollment information for the current date and up to a year previous.
• Check the status and review the history of claims, adjustments, and PA requests and amendments that were previously submitted.
• View other reports and data.
• Access various training courses, as well as a new online handbook, which is an interactive tool containing policy information for all health care programs.

The Portal supplements and compliments existing ways for providers to do business with state health care programs. Providers will continue to be able to submit paper claims and PA requests, as well as use the Automated Voice Response system, Wisconsin Enrollment Verification System, Specialized Transmission Approval Technology-PA, Provider Electronic Solutions (PES) claims submission software, and Provider Services.

Provider Agreements

All Medicaid-certified providers are required to complete and submit a new Wisconsin Medicaid Provider Agreement and Acknowledgement of Terms of Participation in order to conduct business via the Portal. Providers will either receive a provider agreement in the mail to complete and send back or will be asked to participate in a recertification.

Important Note
Providers must create and establish an account to continue to conduct business electronically with BadgerCare Plus or have access to the secure area of the Portal.

Trading Partner Profile

All trading partners, including those trading partners who are also providers, are required to complete a new Trading Partner Profile, HCF 13043, and create an account through the Portal. To establish an account, trading partners will use a unique personal identification number that will be issued automatically upon completion of a new Trading Partner Profile.

Testing Required

Once an account is established, trading partners may conduct testing of electronic transactions beginning on June 2, 2008. Providers who currently act as trading partners and exchange electronic transactions (e.g., 837 Health Care Claim, 270/271 Health Care Eligibility/Benefit Inquiry and Information Response), including users of PES software, are required to conduct trading partner testing to verify that their transactions will process when the new system is functional in October 2008.

Non-managed care organization trading partners must complete authorization testing, as directed in the trading partner testing packets, before October 2008.

More Information

More information about ForwardHealth interChange; testing for providers, trading partners, third-party vendors, and state-contracted managed care organizations; and timelines for these activities will be issued in future publications.