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Acute and Primary Managed Care

Welcome » April 23, 2024 1:46 PM

	Alerts
	While some disruption is still occurring due to the cyber security incident involving Change Healthcare, providers who use Change Healthcare may once again submit pharmacy Point-of-Sale claims. Visit the ForwardHealth Change Healthcare Service Interruption: Resources page for more information. 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.

HMO Providers

This page provides resources and general information for Medicaid providers that are enrolled, or seeking to enroll, with a BadgerCare Plus or Medicaid SSI HMO.

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

Provider Enrollment Information
This page provides a complete description for how providers can enroll with Wisconsin Medicaid.

ForwardHealth Provider Enrollment Assistance
ForwardHealth Provider Services Call Center 800-947-9627

The call center is available Monday through Friday, 7 a.m. — 6 p.m. (Central time, with the exception of state-observed holidays).
Providers should call Provider Services for enrollment, policy, and billing questions.

How to Enroll With an HMO
To enroll in an HMO network, contact the plan’s provider relations team.
Contact information can often be found on the HMO’s website.

Member HMO Enrollment Verification
Member enrollment verification on the Portal offers real-time member enrollment verification for all ForwardHealth programs.

For managed care policy, contact the appropriate managed care organization.

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.

Request Portal Access
Providers are strongly encouraged to receive access to and use the secure ForwardHealth Portal. Registering with the ForwardHealth Portal will ensure providers have access to ForwardHealth Updates.

Claim Submission and Provider Appeal Tips

Verify Member Enrollment. Providers should make sure to submit all claims to the appropriate HMO. They can verify a member’s HMO enrollment on the ForwardHealth Portal.

HMO contracts set filing guidelines for claims submissions, reconsiderations, and appeals.

Providers must submit claims completely, accurately, and timely to their HMO to avoid claim denials.

Providers must appeal to the HMO first. Providers can only appeal to DHS after exhausting the HMO appeal process. Providers that do not exhaust the HMO appeal process will have their appeal rejected by DHS.

ForwardHealth Provider Appeals Page
The Provider Appeals page contains instructions on filing a provider appeal including references to appeal rights allowed to providers who contract with HMOs, references to the BadgerCare Plus and Medicaid SSI HMO contract, responsibilities of the HMOs to BadgerCare Plus and Medicaid SSI HMO providers, and guidance instructing providers to access each HMO’s provider handbook for HMO-specific processes.

Member HMO Enrollment Verification
Member enrollment verification on the Portal offers real-time member enrollment verification for all ForwardHealth programs.

Provider Services and Resources Reference Guide
A list of services and resources available to providers and members with contact information and hours of availability.

Provider-Specific Resources by Provider Type
This page lists resources and information organized by provider type including medical necessity criteria, targeted trainings, relevant ForwardHealth topics, and other materials.

Provider Relations Map
This map provides contact information for provider relations field representatives and the regions they cover. ForwardHealth professional relations representatives are unable to assist with some HMO-related provider topics. Providers are encouraged to work with the HMO prior to reaching out to their ForwardHealth field representative.

BadgerCare Plus and Medicaid SSI HMO Contract
This page provides the current BadgerCare Plus and Medicaid SSI contract and amendments.

HMO Billing Contact Information

HMO	Contact Name	Phone	Email/Web Contact
Anthem	Provider Relations	855-558-1443	https://providers.anthem.com/wisconsin-provider/contact-us
Chorus Community Health Plans (CCHP)		800-482-8010	https://chorushealthplans.org/for-providers/provider-overview
Dean	Customer Service Center	608-828-1301 or 800-279-1301	https://www.deancare.com/providers
GHC-EC	Margie Ignarski, Director of Operations	715-852-2091	mignarski@group-health.com
GHC-SCW	Claims Department	608-251-4526	claimsdepartment@ghcscw.com
iCare	Denise Mays	414-231-1084	dmays@icarehealthplan.org
My Choice Wisconsin SSI Medicaid	Customer Service	800-963-0035	N/A
My Choice Wisconsin BadgerCare Plus	Customer Service	414-755-3619 or 855-530-6790	N/A
MercyCare	Claims Processing: Betsy Fulmer	608-752-3431	bfulmer@mhemail.org
MHS	Joanne Jackson, Director of Operations	414-773-4149	jojackson@mhswi.com
Molina	Claims Processing, Deanna Deubig	414-260-9087	Deanna.Deubig@MolinaHealthcare.com
NHP	Joanne Jackson, Director of Operations	414-773-4149	jojackson@mhswi.com
Quartz	Quartz Customer Service	800-362-3310	customerservice@quartzbenefits.com
Security	Claims Processing: April Bores	715-221-9412	bores.april@securityhealth.org
UHC	Provider Call Center	877-651-6677	https://www.uhcprovider.com/en/health-plans-by-state/wisconsin-health-plans/wi-comm-plan-home.html

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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