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Acute and Primary Managed Care
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Alerts
  • Children’s Long-Term Support (CLTS) Program Providers and County Waiver Agencies: The CLTS Operations Team is available for your questions about submitting prior authorizations (PAs) or claims for CLTS services. Reach the CLTS Operations Team at 844-942-5870 or CLTSOperations@gainwelltechnologies.com.
  • Attention CLTS Providers: The CLTS Prior Authorization Conversion is still processing. If you have any difficulties submitting claims, please contact the CLTS Operations Team at 844-942-5870 or CLTSOperations@gainwelltechnologies.com.
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HMO Administrators


This page provides resources and general information for staff and administrators of BadgerCare Plus or Medicaid SSI HMOs.

For information specific to members, visit the Wisconsin Department of Health Services(DHS) site.


Initial Readiness Assessment for the BadgerCare Plus and Medicaid SSI HMO Program
A completed readiness assessment is required to become a BadgerCare Plus or Medicaid SSI HMO.
Contract for BadgerCare Plus and/or Medicaid SSI HMO Services
A signed contract is required to become a BadgerCare Plus or Medicaid SSI HMO.
Enrollment Counts and Population Explanations
The Medicaid managed care enrollment reports provide a retrospective (rather than prospective) view of Wisconsin managed care enrollment information. The reports reflect a six-month rolling time frame and have been updated to provide enrollment counts by recipient county of residence.
Contracts and Amendments
BadgerCare Plus and Medicaid SSI HMOs are expected to adhere to their contracts.
ForwardHealth Updates
ForwardHealth Updates announce changes in policy and coverage, prior authorization requirements, and claim submission requirements. They communicate new initiatives from DHS or new requirements from the Centers for Medicare & Medicaid Services and the Wisconsin state legislature.
ForwardHealth Online Handbook
Providers should refer to the ForwardHealth Online Handbook for current ForwardHealth policy and provider-specific information for services and benefits.
Report Matrix
This table lists all reports and layouts sent by DHS to HMOs.
HMO Report List
This document lists all contract-specified reports due from HMOs to DHS on a daily, monthly, quarterly, annual, or other basis.
HMO Provider Network Universe
The following link contains file submission specifications and data dictionaries sent by DHS to HMOs.
HMO Quality Information
This page lists HMO quality documents, including quality guides, pay-for-performance (P4P), HMO accreditation deeming plans, HMO report cards, external quality review organization annual technical reports, and quality strategies information for providers.
Encounters and Reporting
The Encounter Data Reporting webpage contains information to assist HMOs in reporting and receiving data associated with their DHS contract.
Reimbursement and Capitation
The Reimbursement and Capitation rates webpage contains information to assist HMOs in receiving reimbursement for services rendered under the DHS contract.
Request Portal Access
HMO administrators are strongly encouraged to receive access to and use the secure ForwardHealth Portal. Registering with the ForwardHealth Portal will ensure that HMO administrators have access to ForwardHealth coverage and billing policies and receive important ForwardHealth Updates.
Report Matrix
This table lists all reports and layouts sent by DHS to HMOs.
Medical Status Codes
This page provides a list of member medical status codes eligible for BadgerCare Plus HMO or SSI HMO enrollment.
Enrollment Counts and Population Explanations
The Medicaid managed care enrollment reports provide a retrospective (rather than prospective) view of Wisconsin managed care enrollment information. The reports reflect a six-month rolling time frame and have been updated to provide enrollment counts by recipient county of residence.
ForwardHealth Trainings
This catalog describes trainings and educational resources for providers and other stakeholders.
User Guides
ForwardHealth user guides and instruction sheets provide ForwardHealth Portal users with step-by-step instructions and screen shots to help navigate Portal functionality.
State of Wisconsin Contact Information
This table contains DHS contact information, including advocates, HMO Ombuds, ForwardHealth Member Services, HMO support, and ForwardHealth Portal Help Desk.
Managed Care Medical Homes
This page provides resources for each of the three medical home programs which serve Wisconsin’s Medicaid managed care programs.

What's New?
A summary of what is new for managed care organizations:


•2025 HMO Quality Guide
 •2025 Initial Readiness Assessment for BadgerCare Plus and WI Medicaid SSI
 •2025 HMO Performance Improvement Project (PIP) Topics, Aims, and Interventions
 •HMO Report List—April 2025 update with link to new Provider Credentialing template added
 •External Quality Review Organization (MetaStar's) Annual Technical Report for Calendar Year 2024
 
 

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