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Children's Long-Term Support (CLTS): Third Party Administration (TPA)Transition for Providers

The claims processor for the CLTS Program will transition from TPA Wisconsin Physicians Service (WPS) to fiscal agent Gainwell Technologies, LLC. (GWT). The anticipated date of this transition is May 5, 2025. This is a temporary webpage that provides information on processes with GWT after the transition. Find information on current processes with WPS.

Claim submission

  • Medicaid IDs (MA IDs) or National Provider Identifiers (NPIs) are required to process CLTS claims.
  • Tax IDs will no longer be accepted.
  • Non-healthcare providers who do not have an NPI will submit claims using their MA ID with all claim submission methods.
  • Healthcare providers who do have an NPI:
    • Must submit the NPI on claims submitted via the electronic 837 method. Cannot submit MA ID on an 837.
    • Will use the MA ID to submit on all other claim submission methods. Can also include NPI.
  • New and existing providers will be assigned an MA ID for the CLTS Program.
  • Providers will receive a letter that will contain their PIN to log in to the ForwardHealth Portal. This letter will also contain their MA ID.
  • Each service location or directory location will have a unique MA ID.
    • Providers are encouraged to ensure their registration is up to date now.
    • The DHS CLTS Registry remains the “source of truth” for provider information, meaning all changes must be made in this registry. DHS passes this information to Gainwell to upload to their provider file and ForwardHealth Portal.
    • If you have one location:
      • Enter this as your main Business Name and Business Address.
      • Enter this as your Directory Location.
    • If you have more than one location:
      • Enter your main location as your Business Name and Business Address.
      • Enter your main location as a Directory Location.
      • Enter all other service locations as a Directory Location.

To update your information, visit the CLTS Provider Registry.

ForwardHealth Portal

  • Direct Data Entry (DDE)
    • Claim Wizard allows providers to directly enter a claim into the ForwardHealth Portal.
  • Copy a Claim
    • The ForwardHealth Portal saves claim information and allows providers to copy a claim, in a paid status, to a new claim for easy editing before submitting it as a new claim.
  • Create a Claim from a prior authorization (PA)
    • Allows users to create a claim based on information from the PA, with information prepopulated on the claim.
  • Electronic Data Interchange (EDI): 837 Health Care Claim transactions
    • 837 transactions will continue to be accepted.
    • Companion guides give ForwardHealth-specific information for exchanging electronic transactions and can be accessed on the Portal.
    • A Resources and EDI Help Desk Information tip sheet is available.

Paper

  • 1500 Health Insurance Claim Form and UB-04 Claim Form
    • Providers can mail in paper claim forms.

Claim adjustments

  • Claim adjustments can be submitted using 837 transactions and DDE.
  • Any claim that is in a Pay status can be adjusted and resubmitted through DDE regardless of how the claim was originally submitted.

CLTS fee schedules

  • The maximum (max) fee schedules can be accessed from the Portal home page and the provider home page.
  • CLTS max fee schedules will be available Spring 2025.

Date-span billing and foster care claims

  • Bill dates of service when services were provided within the authorized date span.
  • When to use a date span versus one day of service:
    • Services were performed on consecutive dates: Bill a date span (for example, Aug. 1–7).
    • Services were performed on two or more different dates: Bill one date per claim line (for example, Aug. 1, Aug. 3, and Aug. 7).

Diagnosis (ICD-10) Codes

New requirement to submit International Classification of Diseases (ICD)-10th Revision Clinical Modification (CM) codes on claims.

  • Will be included on the PA.
  • Will be a specific diagnosis code or Z41.8 – encounter for other procedures for purposes other than remedying health state, unspecified.

Place of Service (POS)

  • New requirement to submit POS code on claims.
  • Will not be included on PA to continue to allow flexibility for POS 02 Remote Services.
    • Guidance will be found in the ForwardHealth Portal in the CLTS Max Fee Schedule for all procedure codes.
    • Guidance will also be found in the Claims Submission User Guide.
    • Will be included in claims submission training closer to the transition date.

Resources

The ForwardHealth Portal has prior authorization (PA) and claims information and secure messaging.

User guides show users how to perform tasks on the ForwardHealth Portal.

Training and other educational resources are also available.

Provider TPA events

Provider webinars

  • October 31, 2024, from 1–2 p.m.
  • December 17, 2024, from 10–11 a.m.

Register for the October webinar

Provider webinars

August 21 and August 28, 2024

Demonstration sessions

August 13 and 15, 2024, How to Submit an 837 Demonstration

July 24 and 25, 2024, Portal and Claims Submission Demonstration Sessions

Provider forums

May 16, 2024, CLTS TPA Transition Provider Forum

January 11, 2024, CLTS Program TPA Transition Financial Management Services Provider Forum

January 9, 2024, CLTS Program TPA Transition Financial Management Services Provider Forum

January 4, 2024, CLTS Program TPA Transition Financial Management Services Provider Forum

November 30, 2023, CLTS Program TPA Transition

Glossary

 
Last revised October 14, 2024