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Welcome  » April 25, 2024 10:16 PM
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Alerts
  • Change Healthcare (CHC) has begun submitting some batch X12 electronic transactions to ForwardHealth. The volume of backlogged claims held by CHC and the amount of time it will take CHC to send them is unknown. Once claims are acquired from CHC, ForwardHealth will process them in the order received.

    Visit the Change Healthcare Service Interruption: Resources page for more information on the security incident and for ForwardHealth resources.

  • Multi-factor authentication (MFA) is now required for the secure ForwardHealth Portal. Providers are encouraged to refer to the ForwardHealth Multi-Factor Authorization Instruction Sheet for help setting up MFA preferences.
    Providers may contact their Portal account administrator or call the ForwardHealth Portal Help Desk at 866-908-1363. Note: This is a project-specific announcement and is not related to the Change Healthcare disruption.
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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.


Certification Application for the BadgerCare Plus and Medicaid SSI HMO Program
A completed Certification Application 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 User Guides
ForwardHealth user guides and instruction sheets provide Portal users with step-by-step instructions and screenshots to help navigate Portal functionality.
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.
Meetings — Parking at DHS
This page provides information on location and parking for the 1 West Wilson Street office.
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 Links
This page provides links to organizational pages for medical associations including the American Academy of Pediatrics, American Dental Association, American Medical Association, American Public Health Association, Wisconsin Immunization Registry, and American Public Human Services Association.
Managed Care Medical Homes
This page provides resources for each of the three state-operated medical home programs which serve Wisconsin’s Medicaid managed care programs.

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


•Better to Illuminate Than Merely to Shine: ForwardHealth Connect
 •Required ForwardHealth Multi-Factor Authentication
 •2023 HMO Quality Guide
 •2023 Performance Improvement Project Proposal and Final Report Template
 •Forward Health Update (2017-22) 'Clarifications to BadgerCare Plus and Medicaid SSI Managed Care Provider Appeal Policy'
 
 

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