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 an authorization from the county waiver agency (CWA) of the county the participant lives in. You can get an authorization in one of two ways:

  • The CWA contacts you about a child who may be a good fit for your services.
  • A family or guardian contacts you directly to discuss and request your services.

You must talk to the CWA to set up the necessary contract with the county. Contracts include proof of training and experience needed for the service and child and background checks. The CWA will determine the service, rate, and frequency that is appropriate for the child. Once you have an authorization from the CWA, you may deliver the authorized 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.

The Wisconsin Department of Health Services (DHS) uses a third-party administrator (TPA) for CLTS provider services.

You can submit claims electronically to the TPA in a few different ways. Find more information about the electronic claim submission and payment options on the WPS CLTS webpage, under “Children’s Long-Term Support Waiver.”

 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

Spreadsheet submission

This is a fast and easy way to submit paperless claims. You must have access to and knowledge of Microsoft Excel or similar spreadsheet software that saves the document in an .xls or .xlsx format.

PC-ACE PRO 32

The TPA offers and supports this free software you can use to submit claims electronically. This software provides an electronic process to receive claims status, perform eligibility searches, and view/print an Electronic Remittance Advice (ERA) in place of paper Provider Remittance Advice (PRA).

Clearinghouse

Contact a clearinghouse or billing service to submit claims on your behalf.

In addition to electronic claim submission options, you can also receive your payments via electronic funds transfer (EFT). When you use EFT, you no longer wait for paper checks delivered through the mail. Instead, deposited payments go right into your checking or savings account.

You may also submit paper claims to the TPA (PDF).

Register for the TPA Provider Portal, which delivers real-time access to claim status, eligibility, secure messaging, and more.

Additional claims submission resources:

Who do I contact with questions?

Registering as a provider

Contact the CLTS Provider Contact Center at 833-940-1576. They can:

  • Answer questions about the registration process.
  • Help you navigate the provider directory.

Getting authorizations to provide services

Contact the local county waiver agencies. They can:

  • Help direct care workers get set up with a fiscal agent or other agency.
  • Help you find more information about becoming a provider in a certain county.
  • Approve you to provide services in a certain county.

Submitting claims and getting paid

Contact the TPA. They can answer questions about claims submission and payment:

Call: 877-298-1258
Email: FCWPS@wpsic.com

Glossary

 
Last revised July 29, 2024