BadgerCare Plus and Medicaid Updates

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2009 ForwardHealth Updates

ForwardHealth Updates — 2009

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Update Number	ForwardHealth Update Topic(s) and release date
2009-98	Changes to the Three-Month Supply of Drugs Policy, 12/1/09
2009-97	New Continuous Stay/Visit Policy for Hospital Services That Span More Than One Date of Service, 12/1/09
2009-96	New Substance Abuse Screening and Intervention Benefit Covered by BadgerCare Plus and Medicaid, 12/1/09
2009-95	Changes to Early Refill Prospective Drug Utilization Review, 12/1/09
2009-94	Procedure Code Updates for Disposable Medical Supplies, 12/1/09
2009-93	Present on Admission Requirements for Inpatient Hospital Claims, 12/1/09
2009-92	Additional Reimbursement for Reporting Body Mass Index for Children, 12/1/09
2009-91	2010 ForwardHealth Portal Fundamentals Training Available, 12/1/09
2009-90	New Information Regarding the Provider Relations Representatives and Other Provider Resources, 12/1/09
2009-89	Changes to Pharmacy Policies Occurring in January 2010, 12/1/09
2009-88	Pharmacy Coordination of Benefits Changes, 12/1/09 *This Update* has been revised since its original publication.** Revisions were made on page 1 of this ForwardHealth Update and are indicated in red.
2009-87	Changes to the Hospital Benefit for the BadgerCare Plus Core Plan, 12/1/09
2009-86	Critical Access Hospital Reimbursement Rates Reduced, 12/1/09
2009-85	New Covered Health Education Benefit for Core Plan Members Diagnosed with Certain Chronic Conditions, 12/1/09
2009-84	Podiatry Services Covered by the BadgerCare Plus Core Plan for Adults with No Dependent Children, 12/1/09
2009-83	BadgerCare Plus Core Plan to Cover Home Health Services Following an Inpatient Hospital Stay, 12/1/09
2009-82	New Policy for the Outpatient Mental Health Benefit and Corrections to Previously Published Information, 12/1/09
2009-81	Hospice Services Covered by BadgerCare Plus Core Plan, 12/1/09
2009-80	Electronic Funds Transfer Payments Available, 11/1/09
2009-79	Specialized Medical Vehicle Providers Are Required to Accept Only the Revised Certification of Need for Specialized Medical Vehicle Transportation Form, 11/1/09
2009-78	SeniorCare Extended to December 31, 2012, 11/1/09
2009-77	Fall 2009 Preferred Drug List Review Phase II Changes, 11/1/09
2009-76	Child Care Coordination Services Expanding to City of Racine, 11/1/09
2009-75	Attendant Care Services Reimbursable Under School-Based Services, 11/1/09
2009-74	Allowable Wisconsin Chronic Disease Program Diagnosis, Procedure, and Revenue Codes and Revised Claim Form Instructions, 11/1/09
2009-73	Overview of ForwardHealth Coverage of 2009 H1N1 and Seasonal Influenza Services, 10/1/09
2009-72	ForwardHealth Discontinues Separate Reimbursement for Care Coordination of Private Duty Nursing Services to Ventilator Dependent Members, 10/1/09
2009-71	Revised Prior Authorization Drug Attachment for Synagis^® Form and Completion Instructions, 10/1/09
2009-70	Copayment and Service Limitations Reset with HMO Enrollment for Members in BadgerCare Plus Core Plan for Adults with No Dependent Children, 10/1/09
2009-69	New Contract for Incontinence and Selected Urological Supplies for Certain BadgerCare Plus and Medicaid Members, 10/1/09 *This Update* has been revised since its original publication to correct the telephone numbers for J&B Medical Supply.** Providers should not distribute copies of the previously-published ForwardHealth Member Update because it contains incorrect telephone numbers for J&B Medical Supply.
2009-68	Changes to Contracted Hearing Aids Effective in September 2009, 10/1/09 *This Update* has been revised since its original publication.** Information about hearing aid model prices and repair warranties have been corrected. See pages 13 and 18 of the Update for more information.
2009-67	Enrollment Verification System Enhancement, 10/1/09
2009-66	Hospice Reimbursement Rate Changes, 10/1/09
2009-65	Rate Changes for Services Receiving Only Federal Funds, 10/1/09 *This Update* has been revised since its original publication.** The rate for Healthcare Common Procedure Coding System procedure code S9484 with modifier "HN" has been corrected. See page 6 of the Update for the revised rate.
2009-64	2009 Rate Changes for School-Based Services, 10/1/09
2009-63	Fall 2009 Preferred Drug List Review, 9/1/09
2009-62	Changes to Adult Mental Health Day Treatment Services as a Result of DHS 35 and Changes to DHS 105 and 107, 11/1/09
2009-61	Changes to Substance Abuse Day Treatment Services as a Result of DHS 35 and Changes to DHS 105 and 107, 11/1/09
2009-60	Changes to the Outpatient Mental Health Benefit as a Result of DHS 35 and Changes to DHS 105 and 107, 10/1/09
2009-59	Changes to Outpatient Substance Abuse Treatment Services as a Result of DHS 35 and Changes to DHS 105 and 107, 10/1/09
2009-58	New Reimbursement Rates for Certain Professional Services Effective October 1, 2009, 10/1/09 *This Update* has been revised since its original publication.** Information for procedure code 27158 has been corrected. See page 5 of the Attachment for more information.
2009-57	ForwardHealth Holiday and Furlough Day Schedule, 9/1/09
2009-56	New Modifier for Nonelective Cesarean Sections, 9/1/09
2009-55	Revenue Code 0191 Is No Longer Reimbursable for Nursing Home Services, 9/1/09
2009-54	Training Sessions Available for Dental Providers, 9/1/09
2009-53	Prior Authorization Procedures for Anti-Obesity Drugs, 9/1/09
2009-52	New Prior Authorization Criteria for Lovaza, 9/1/09
2009-51	Rate Changes for Case Management Services, 9/1/09
2009-50	Provider Electronic Solutions Software Training Available, 9/1/09 *This Update* has been revised since its original publication.** The June 17, 22, and 24, 2010, Provider Electronic Solutions claims submission software training sessions for Dental and Pharmacy claims will not be held at their scheduled locations. Instead, a real-time, Web-based training session facilitated through HP^® Virtual Room will be conducted on June 24, 2010. Registration is still required for these sessions. Refer to the Providers Trainings page of the ForwardHealth Portal at www.forwardhealth.wi.gov/ for more information.
2009-49	Introducing the Drug Authorization and Policy Override Center and Prior Authorization Requirements for Synagis^®, 9/1/09
2009-48	Therapy Services Provided in Schools Are Not Counted Toward Community-Based Therapy Limits, 9/1/09
2009-47	Modifier "UA" Replaces Discontinued Modifier "RP" for Vision Services, Effective January 1, 2009, 8/1/09
2009-46	Claims Submitted with Dispense As Written Code "6", 8/1/09
2009-45	Prospective Drug Utilization Review Alerts, 8/1/09
2009-44	New Location for Submitting the Wisconsin Well Woman Medicaid Determination Form and Form Revisions, 8/1/09 *This Update* has been revised since its original publication** to include the full name of the Wisconsin Well Woman Medicaid Determination form, F-10075 (07/09), and to update the e-mail address for submitting the form.
2009-43	Revised Process for Family Planning Waiver Enrollment Applications, 8/1/09
2009-42	Revised Forms for Nursing Facilities, 7/1/09
2009-41	Patient Liability and Level of Care Information Is Only Available via the ForwardHealth Portal Beginning in August 2009, 7/1/09
2009-40	Claims for Outpatient Hospital Services Do Not Require Value Codes 80 and 81 (Covered and Noncovered Days), 7/1/09
2009-39	Changes to Hearing Aid Contracts Effective July 1, 2009, 7/1/09
2009-38	Women Diagnosed with Breast Cancer or Cervical Cancer While Enrolled in BadgerCare Plus Benchmark Plan or BadgerCare Plus Core Plan Are Now Eligible to Be Enrolled in Wisconsin Well Woman Medicaid, 7/1/09 *This Update* has been revised since its original publication.** The e-mail address for submitting the Wisconsin Well Woman Medicaid Determination form has been updated.
2009-37	BadgerCare Plus and Medicaid Basics Training Available for All Providers, 6/1/09
2009-36	Reimbursement Change for SeniorCare, 6/1/09
2009-35	Hospice Reimbursement Rate Changes, 6/1/09
2009-34	BadgerCare Plus Core Plan for Adults with No Dependent Children-Covered Pharmacy Services, 6/1/09
2009-33	Expansion of the BadgerCare Plus Core Plan for Adults with No Dependent Children, 6/1/09 *This Update* has been revised since its original publication.** Information about BadgerCare Plus Benchmark Plan coverage of routine vision services in Attachment 5 has been corrected.
2009-32	Ostomy Supplies Are Covered by BadgerCare Plus Benchmark Plan, 6/1/09
2009-31	New Frames Available Through the Medicaid State Purchase Eyeglass Contract, 6/1/09
2009-30	Pharmacy Coordination of Benefits Clarification for Other Coverage Code 4, 5/1/09
2009-29	ForwardHealth Portal Fundamentals Training Available for All Providers, 5/1/09 *This Update* has been revised since its original publication.** The training sessions have been extended by 30 minutes. The new end times are noted in the revised Attachment.
2009-28	ForwardHealth Announces Revisions to the Certification of Need for Specialized Medical Vehicle Transportation Form and Completion Instructions, 5/1/09 *This Update* has been revised since its original publication.** Elements 13 and 14 of the form are now optional. See Attachment 2 for a revised version of the form.
2009-27	Procedure Code Updates for Disposable Medical Supplies, 5/1/09
2009-25	Clarification of Policy and Reimbursement for Provider-Administered Drugs, 5/1/09
2009-24	Procedure Code Change for Therapeutic, Prophylactic, or Diagnostic Injections, 5/1/09
2009-23	Revision to Claim Form Completion Instructions for Specialized Medical Vehicle Providers, 5/1/09
2009-22	Changes to Eligibility for the Continuously Eligible Newborn Option, 5/1/09
2009-21	Clarification of Reimbursement of Dental Services under the BadgerCare Plus Core Plan for Childless Adults, 5/1/09
2009-20	Changes to the Newborn Report Form, 5/1/09
2009-19	Swine Flu Antiviral Drugs Are Temporarily Covered by the BadgerCare Plus Benchmark Plan and the BadgerCare Plus Core Plan, 5/1/09
2009-18	ForwardHealth Will Require '01' in the Prescriber ID Qualifier Field on Point-of-Sale Real-Time Pharmacy Claims, 4/1/09
2009-17	BadgerCare Plus Core Plan for Childless Adults Training Sessions Available for All Providers, 4/1/09
2009-16	Revised Cost Report Forms for Rural Health Clinics, 4/1/09
2009-15	Revised Cost Report Forms for Federally Qualified Health Centers, 4/1/09
2009-14	Hospice Services Under the BadgerCare Plus Benchmark Plan Do Not Have Copayments, 4/1/09
2009-13	Revised Presumptive Eligibility for the Family Planning Waiver Application and Instructions, 4/1/09
2009-12	Changes to Pharmacy Coverage Under the BadgerCare Plus Core Plan for Childless Adults Delayed, 4/1/09
2009-11	Changes to Express Enrollment in BadgerCare Plus for Children and Pregnant Women, 3/1/09 *This Update* has been revised since its original publication.** Effective June 14, 2010, the Federal Poverty Level for children younger than age 1 has changed from 250 percent to 300 percent, as indicated in the red text below.
2009-10	Spring 2009 Preferred Drug List Review, 3/1/09
2009-09	Copayment Policy Clarification for Members in Foster Care, Subsidized Adoption, and the Katie Beckett Program, 3/1/09
2009-08	Personal Care Activity Time Allocation Table Revised, 3/1/09
2009-07	2009 CPT and HCPCS Procedure Code Changes for Physicians and Related Providers, 3/1/09
2009-06	Reimbursement Changes for Family Planning Clinics, 2/1/09
2009-05	Medicare Grouper Version 25 Implementation and Claim Adjustments, 2/1/09
2009-04	Pharmacy Coordination of Benefits Clarifications, 2/1/09
2009-03	1099 Miscellaneous Form for the 2008 Tax Year from ForwardHealth, 1/1/09
2009-02	HealthCheck Outreach Services Are Covered by the BadgerCare Plus Benchmark Plan, 1/1/09
2009-01	Clarifications and Changes to Dental Services for Members Enrolled in Medicaid and BadgerCare Plus, 1/1/09

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