wisconsin.gov HomeState AgenciesDepartment of Health Services
Welcome  » May 12, 2024 8:26 AM
Login
Search
Alerts
  • Ascension Password Change: On May 8, 2024, a cyber security event disrupted clinical operations of the Ascension Healthcare Network. To ensure the security of protected health information on the ForwardHealth Portal, ForwardHealth will prompt all providers owned by Ascension to change their password. Providers not owned by Ascension will not be prompted to change their password.

    For instructions on changing your Portal password, refer to the ForwardHealth Provider Portal Account User Guide.

  • 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.
Pharmacy Provider Publications

Pharmacy Provider Publications

These publications are available only as PDFs. You will need Adobe Reader® to view these files.

Update
Number		Update Topic and Release Date
2019
2019-11 SeniorCare Waiver Given Temporary Extension, 4/3/19
2019-10 Pharmacy Policy Changes for Adderall XR Effective May 1, 2019, 3/13/19
2019-04 SeniorCare Waiver Given Temporary Extension for 60 Days, 1/31/19
2019-03 Brand Name Metadate CD No Longer Available, 1/28/19
2018
2018-48 Policy Changes for Alpha Hydroxyprogesterone Caproate (17P) Compound and Makena Injections, 12/18/18
2018-47 January 2019 Preferred Drug List Review and Other Pharmacy Policy Changes, 12/14/18
2018-45 SeniorCare Waiver Given Temporary Extension to January 31, 2019, 12/7/18
2018-44 Changes to Prior Authorization for Migraine Agents, CGRP Antagonists, 12/7/18
2018-43 Changes to Certain Durable Medical Equipment Maximum Allowable Fees, 12/4/18
2018-42 ForwardHealth Interim Coverage of Select Drugs, Including High Cost Drugs, Orphan Drugs, and Drugs Approved Under an FDA Accelerated Approval Pathway, 12/3/18
2018-41 Reactivation of Prospective Drug Utilization Review — Patient Age Alert for Children, 11/26/18
2018-34 Pharmacy Policy Changes Effective September 21, 2018, 9/21/18
2018-32 New Coverage and Clarified Prior Authorization Policy for Mobility Devices, 9/13/18
2018-22 July 2018 Preferred Drug List Review and Other Pharmacy Policy Changes, 6/15/18
2018-19 Drug Coverage Limitations for SeniorCare Members, 6/4/18
2018-10 New Face-to-Face Visit Requirement and Changes to Policy for Home Health Services, Durable Medical Equipment, and Disposable Medical Supplies, 3/5/18
2017
2017-42 January 2018 Preferred Drug List Review and Other Pharmacy Policy Changes, 12/15/17
2017-39 Expanded List of Allowable Vaccines for Pharmacy Providers, 12/4/17
2017-34 New and Clarified Pharmacy Policy and Claims Submission Requirements, 10/26/17
2017-32 Prior Authorization Required for Mavyret™ and Vosevi™, 10/6/17
2017-17 July 2017 Preferred Drug List Review and Other Pharmacy Policy Changes, 6/16/17

June 21, 2017: This Update has been revised with additional information since its original publication. Information under Olysio® as Combined with Sovaldi® has been added in red text on page 17 of the Update.
2017-16 Prior Authorization Required for Spinraza™, 5/24/17
2017-07 Changes to Billing and Reimbursement Policy for Covered Outpatient Drugs, 3/15/17
2017-02 New Coverage Policy for Home Ventilator Rental, 1/26/17
2016
2016-54 January 2017 Preferred Drug List Review and Other Pharmacy Policy Changes, 12/16/16

March 6, 2017: This Update has been revised since its original publication. Information under the Clinical Criteria for Cytokine and CAM Antagonist Drugs for Crohn's Disease section has been added in red text on page 9 of the Update.
2016-48 ForwardHealth Coverage and Prior Authorization Policy for Personal Continuous Glucose Monitoring Devices and Accessories, 10/27/16
2016-32 Revised Prior Authorization Forms and Changes to Pharmacy Policies for Hepatitis C Agents Effective August 1, 2016, 7/29/16
2016-30 Pharmacy Policy Changes Effective August 1, 2016, 7/18/16
2016-28 Prior Authorization No Longer Required for Cochlear Implant and Bone-Anchored Hearing Device Implant Surgeries, 7/13/16
2016-24 New Coverage and Prior Authorization Policy for Gait Trainers, 6/22/16
2016-22 July 2016 Preferred Drug List Review and Other Pharmacy Policy Changes, 6/17/16
2016-21 Prior Authorization Will No Longer Be Required for Crinone® 8% When Used for Certain Indications, 6/7/16
2016-19 Prior Authorization Required for Rosuvastatin Tablets, 5/24/16
2016-18 Date of Service Defined and Documentation Requirements Clarified for Durable Medical Equipment and Disposable Medical Supplies, 5/16/16
2016-14 Changes to Pharmacy Policies for Hepatitis C Agents, 4/13/16
2016-12 Changes to Prospective Drug Utilization Review Alerts, 4/1/16
2016-07 Revised Prior Authorization Criteria and Coverage Policy for Cochlear Implant Surgery, 2/23/16
2016-06 Prior Authorization Required for Generic Imatinib Tablets, 2/1/16
2015
2015-65 Overview and Clarification of Hearing Instrument Battery Policy, 12/28/15
2015-63 SeniorCare Waiver Extended to December 31, 2018, 12/21/15
2015-61 January 2016 Preferred Drug List Review and Other Pharmacy Policy Changes, 12/18/15
2015-57 Prior Authorization Required for Paliperidone Tablets, 11/02/15
2015-50 Pharmacy Policy Changes Effective October 15, 2015, 10/5/15
2015-49 New Coverage and Prior Authorization Policy for Wearable Cardioverter Defibrillators, 10/2/15
2015-45 New Coverage and Prior Authorization Policy for Cranial Remolding Orthosis, 9/14/15
2015-36 Change to Prospective Drug Utilization Review Alerts, 8/10/15
2015-34 Revised Prior Authorization Drug Attachment for Hepatitis C Agents Effective August 1, 2015, 7/22/15
2015-29 Drug-Related Supplies Reimbursed Fee-for-Service for Outpatient Pharmacies, 6/29/15
2015-27 July 2015 Preferred Drug List Review and Other Pharmacy Policy Changes, 6/17/15

February 23, 2016: This Update has been revised since its original publication. Information under the Clinical Criteria for Pediatric-Covered Indications for Growth Hormone Drugs section has been added in red text on page 10 of the Update.
2015-20 New Prior Authorization Criteria for Bone Growth Stimulators, 5/22/15
2015-19 Prior Authorization Changes for a Bone-Anchored Hearing Device Implant Surgery and Non-implant Bone-Anchored Hearing Device, 5/14/15
2015-13 Changes to Pharmacy Policies for Hepatitis C Agents Effective April 1, 2015, 3/18/15
2015-09 Clarification Regarding Comprehensive Medication Review and Assessment Services for Members Recently Discharged from a Hospital or Long Term Care Setting, 3/6/15
2015-04 Coverage Policy for Continuous Glucose Monitoring, 1/12/15
2014
2014-79 Changes to Provider-Administered Drugs Carve-Out Policy, 12/16/14
2014-78 January 2015 Preferred Drug List Review and Other Pharmacy Policy Changes, 12/18/14
2014-77 Change to Requirement Regarding Electronic Submission of Medication Therapy Management Documentation, 12/11/14
2014-75 Procedure Code Changes for Influenza Vaccinations, 12/4/14
2014-74 Changes to Pharmacy Policies for Hepatitis C Agents Effective December 1, 2014, 11/19/14
2014-68 New Program Requirements for Dispensing Clotting Factor Concentrates, 10/27/14
2014-62Changes to the 1500 Health Insurance Claim Form and Completion Instructions, 10/14/14
2014-55 Changes to Pharmacy Policies Effective October 1, 2014, 9/17/14
2014-53 Revised Prior Authorization Guidelines for Synagis®, 9/15/14

September 16, 2014: This Update has been revised since its original publication. Information under the Chronic Lung Disease of Prematurity section has been changed to clarify the gestational age at delivery is younger than 32 weeks. Revisions are indicated in red.
2014-45Medication Therapy Management New Electronic Submission of Documentation Requirement, 8/18/14
2014-39July 2014 Preferred Drug List Review and Other Pharmacy Policy Changes, 6/20/14
2014-302014 Procedure Code Changes for Durable Medical Equipment, 4/30/14
2014-242014 Procedure Code Changes for Disposable Medical Supplies, 3/31/14
2014-22Revision to Durable Medical Equipment Coverage, Policies, and Limitations, 4/30/14
2014-20Policy Changes for Alpha Hydroxyprogesterone Caproate (17P) Compound Injections and Makena Injections, 3/31/14
2014-13Prior Authorization Required for Sovaldi™, 3/3/14
2014-08Changes to Pharmacy Policies Effective March 1, 2014, 2/17/14
2013
2013-67January 2014 Preferred Drug List Review and Other Pharmacy Policy Changes, 12/13/13
2013-56ForwardHealth Encourages Providers to Include Specific Explanation of Medicare Benefits Information with Medicare Advantage Crossover Claims for Diabetic Supplies, 10/24/13
2013-53Revisions to Payer Sheet for All ForwardHealth Programs as a Result of Changes to Claims Submission Requirements for Wisconsin AIDS Drug Assistance Program, 10/9/13
2013-47Additional Information and Clarifications Regarding Professional Claims for Compound and Noncompound Drugs, 9/26/13
2013-46Changes to Pharmacy Policies Effective Fall 2013, 9/18/13

September 19, 2013: This Update has been revised since its original publication. Information on page 4 regarding PA requests for Anti-obesity drugs and information on pages 6 through 8 regarding a prescriber's handwritten signature on the PA/DGA form have been revised. Revisions are indicated in red.
2013-42Policy Clarifications for OnabotulinumtoxinA (Botox®) and Other Botulinum Toxins, 9/5/13
2013-41Clarification for the Revised Prior Authorization/ Preferred Drug List (PA/PDL) Exemption Request Form and Completion Instructions, 8/20/13
2013-39Pharmacy Providers May Contract with a ForwardHealth-Approved Medication Therapy Management Case Management Software Vendor, 8/1/13
2013-35July 2013 Preferred Drug List Review and Other Pharmacy Policy Changes, 6/20/13
2013-29New Monthly Maximum Quantity Limit and Coverage Criteria for Selected Incontinence Supplies, 5/7/13
2013-20Information and Policy Clarifications for the Medication Therapy Management Benefit, 3/26/13
2013-14Policy for Onabotulinumtoxin A (Botox®), 2/21/13
2013-062013 Procedure Code Changes for Disposable Medical Supplies, 1/24/13
2013-04Reminder: Reimbursement for Certain Disposable Medical Supplies, Durable Medical Equipment, and Enteral Nutrition Products Included in Nursing Home Daily Rate, 1/28/13
2013-032013 Procedure Code Changes for Durable Medical Equipment, 1/31/13
2012
2012-72SeniorCare Extended to December 31, 2015, 12/27/12
2012-71January 2013 Preferred Drug List Review and Other Pharmacy Policy Changes, 12/21/12

2/22/2013: This Update has been revised since its original publication. On page 8, the name of the preferred drug in the Cytokine and CAM antagonist drug class used to treat ulcerative colitis has been changed to Humira®.
2012-63Reminder: Reimbursement for Certain Over-the-Counter Drugs and All Diabetic Supplies Are Included in the Nursing Home Daily Rate, 11/15/12
2012-57Enteral Nutrition Products Policy, 10/12/12
2012-46Changes to Prospective Drug Utilization Review Alerts, 9/11/12
2012-44ForwardHealth Will No Longer Mail Prior Authorization Decision Notice Letters for Drugs Approved Through STAT-PA System, 9/11/12
2012-43New Durable Medical Equipment Index Available, 8/31/12
2012-42Disposable Medical Supplies Procedure Code Clarification, 8/24/12
2012-39Medication Therapy Management Benefit, 8/23/12
2012-29Introducing the Medication Therapy Management Benefit, 6/29/12
2012-25Summer 2012 Preferred Drug List Review and Other Pharmacy Policy Changes, 6/19/12
2012-19Policy Changes for Bone-anchored Hearing Aids, 5/14/12
2012-07Spring 2012 Pharmacy Policy Changes, 3/9/12
2012-042012 Procedure Code Changes for Durable Medical Equipment, 2/17/12
2012-03Procedure Code Changes for Disposable Medical Supplies, 2/17/12
2012-01New Prior Authorization Policy for Antipsychotic Drugs for Children 6 Years of Age and Younger, 1/26/12

This Update has been revised since its original publication. The end date for the Attestation to Prescribe More Than One Antipsychotic Drug for a Member 16 Years of Age or Younger is for dates of process on and after February 15, 2012, not for dates of service on and after February 14, 2011.
2011
2011-88Enteral Nutrition Product Criteria for Coverage and Other Policy Information, 12/28/11
2011-84January 2012 Preferred Drug List Review and Other Pharmacy Policy Changes, 12/20/11
2011-78Clarification of Provider Responsibilities for Requesting and Amending Prior Authorizations for Synagis®, 11/22/11
2011-77Changes to Reimbursement for Exceptional Supplies for Nursing Home Residents, 11/22/11
2011-72Implementation of the HIPAA Accredited Standards Committee X12 Version 5010 Electronic 278 Health Care Services Review — Request for Review and Response Transaction, 11/7/11
2011-69Changes to Alpha Hydroxyprogesterone Caproate (17P) Compound Injection Policy and New Makena Injection Policy, 11/2/11

This Update has been revised since its original publication. Effective for dates of service on and after January 1, 2012, procedure code J1725 is required on claims for alpha hydroxyprogesterone caproate (17P) compound injection and Makena injection. Refer to pages 2 and 4 of this Update for revised information.
2011-63New Reimbursement Policies for Influenza Immunizations Administered by Pharmacy Providers, 10/21/11
2011-57Changes to Claims for Drugs and Diabetic Supplies Resulting from Implementation of the National Council for Prescription Drug Programs Telecommunication Standard Version D.0, 9/23/11
2011-56Changes to Pharmacy Policies Effective in October 2011, 9/21/11
2011-54New Reimbursement Methodologies for Drugs and Diabetic Supplies, 9/20/11
2011-52Revisions to 1500 Health Insurance Claim Form Instructions Resulting from HIPAA ASC X12 Version 5010 Implementation, 9/14/11
2011-49Changes to Prior Authorization for Drugs and Diabetic Supplies Resulting from Implementation of the National Council for Prescription Drug Programs Telecommunication Standard, 8/31/11
2011-48Additional Power Sources Not Covered and Changes to Coverage for Ventilator Equipment, 8/24/11
2011-38Wisconsin Chronic Disease Program Training Available, 7/25/11
2011-37National Provider Identifier Policy Clarification for Durable Medical Equipment Providers, 7/8/11
2011-36Summer 2011 Preferred Drug List Review, 7/11/11

August 8, 2011: A clarification has been made on page 9 to the clinical criteria for non-preferred orally disintegrating PPI tablets.
July 15, 2011: An additional revision has been made on pages 6 and 7 as a result of the retroactive policy change.
July 11, 2011: Retroactive for dates of service on and after July 1, 2011, simvastatin 80mg will remain a preferred drug. Page 7 of this Update has been revised to reflect the change in policy. The Preferred Drug List Quick Reference pharmacy data table was revised and posted to the ForwardHealth Portal on July 7, 2011, to reflect the change in policy. In addition, a change to the clinical criteria for proton pump inhibitor drugs was made on page 9.
2011-29Policy Clarification for Cochlear Implants, 5/11/11
2011-282011 Procedure Code Updates for Durable Medical Equipment, 5/11/11
2011-27Policy Changes and Reminders for Gradient Compression Garments and Compression Burn Garments, 4/26/11
2011-21Changes to the Coverage of Active Pharmaceutical Ingredients and Excipients for Compound Drugs, 3/1/11
2011-20Changes to Pharmacy Policies Effective in April 2011, 3/1/11
2011-13Important Information About the National Correct Coding Initiative, 3/1/11
2011-09Introducing Two New Reports for Compound and Noncompound Drug Claims, 2/1/11
2011-07Explanation of Benefits Code for Generic Drug Reimbursement, 1/1/11
2011-06Three-Month Supply Drug Policy Changes, 1/1/11
2011-04Changes to the Pharmacy Services Lock-In Program, 1/1/11
2010
2010-119How to Correctly Indicate Modifiers on Claims for Repeat or Separately Identifiable Procedures, 12/1/10
2010-118Real Time and Provider Electronic Solutions Claim Response Enhancement, 12/1/10
2010-117Over-the-Counter Drug Policy, 12/1/10
2010-115Documentation Requirements and Changes to Prior Authorization and the Reimbursement Rate for Negative Pressure Wound Therapy Pumps, 12/1/10
2010-112Opioid Monthly Prescription Fill Limit, 12/1/10
2010-108Diabetic Supply Policy Changes, 12/1/10
2010-103Changes to Pharmacy Policies Occurring in December 2010, 11/1/10
2010-99Coverage of Certain Asthma Supplies Under the BadgerCare Plus Benchmark Plan, the BadgerCare Plus Core Plan, and the BadgerCare Plus Basic Plan, 11/1/10
2010-97Clarification for Extraordinary Claims Submission for Professional Services, 11/1/10
2010-95Changes to the Family Planning Waiver Effective November 2010, 11/1/10
2010-90Reimbursement Reduction for Most Paper Claims Submitted to ForwardHealth, 10/1/10
2010-86Prior Authorization Is Required for Avandia, Avandamet, and Avandaryl, 9/1/10
2010-85Reimbursement Rate Increase for Pharmacy Providers for Therapeutic Interchange and Influenza Vaccine, 9/1/10
2010-84Fall 2010 Preferred Drug List Changes, 9/1/10
2010-82Prior Authorization Is Required for Certain Durable Medical Equipment Under the BadgerCare Plus Core Plan and the BadgerCare Plus Basic Plan, 9/1/10
2010-74Reminder of Deficit Reduction Act Policy for Prescribers, 8/1/10

This Update has been revised since its original publication. Information about Provider Electronic Solutions software has been corrected. Refer to page 2 of the Update for more information.
2010-72ClaimCheck Clarification, 8/1/10
2010-67Hearing Instruments and Services Now Covered Under the BadgerCare Plus Benchmark Plan, 7/1/10
2010-63Compound and Noncompound Drug Claim Submissions Using the ForwardHealth Portal, 8/1/10
2010-57July 2010 Preferred Drug List Review and Other Pharmacy Policy Changes, 6/1/10
2010-56Changes to Two Provider-Administered Drug Categories Related to Reproductive Health for Females, 6/1/10
2010-55Clarification of Policy and Coverage for Incontinence and Urological Supplies Included in the J&B Medical Supply Contract, 6/1/10
2010-52Pharmacy Services Covered Under the BadgerCare Plus Basic Plan, 6/1/10

This Update has been revised since its original publication. The Explanation of Benefits code on page 5 has been revised.
2010-48Durable Medical Equipment Covered Under the BadgerCare Plus Basic Plan, 6/1/10
2010-47Disposable Medical Supplies Covered Under the BadgerCare Plus Basic Plan, 6/1/10
2010-39Coverage of Cervarix® and Changes to the Coverage of Gardasil®, 5/1/10
2010-36Some Males Now Eligible for the Family Planning Waiver, 5/1/10

This Update has been revised since its original publication. The URL to ACCESS has been corrected. See the correct URL indicated in red at the bottom of page 1.
2010-30Changes for Diabetic Supplies, 4/1/10
2010-29Specialty Pharmacy Drug Reimbursement Rate Changes, 4/1/10
2010-26Procedure Code Updates for Durable Medical Equipment, 3/1/10
2010-25New Reimbursement Policies for Immunizations Given to BadgerCare Plus and Medicaid Members, 5/1/10
2010-23Spring 2010 Preferred Drug List Review, 3/1/10
2010-20Changes to the Pharmacy Data Tables, 3/1/10
2010-14New Policies and Clarification of Certain Pharmacy Policies, 2/1/10

This Update has been revised since its original publication. Revisions were made on page 2 of this ForwardHealth Update and are indicated in red.
2010-13Clarification and New Policies for Drugs for Prescribers, 2/1/10

This Update has been revised since its original publication. Revisions were made on page 2 of this ForwardHealth Update and are indicated in red.
2010-11New Implementation Date and Clarification of Incontinence and Urological Supply Coverage for the J&B Medical Supply Contract, 2/1/10
2010-04Quantity Limits for Certain Drugs, 2/1/10
2010-01Preferred Drug List Changes, 1/1/10
2009
2009-98Changes to the Three-Month Supply of Drugs Policy, 12/1/09
2009-95Changes to Early Refill Prospective Drug Utilization Review, 12/1/09
2009-94Procedure Code Updates for Disposable Medical Supplies, 12/1/09
2009-89Changes to Pharmacy Policies Occurring in January 2010, 12/1/09
2009-88Pharmacy 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.
2009-78SeniorCare Extended to December 31, 2012, 11/1/09
2009-77Fall 2009 Preferred Drug List Review Phase II Changes, 11/1/09
2009-73Overview of ForwardHealth Coverage of 2009 H1N1 and Seasonal Influenza Services, 10/1/09
2009-71Revised Prior Authorization Drug Attachment for Synagis® Form and Completion Instructions, 10/1/09
2009-69New 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.
2009-63Fall 2009 Preferred Drug List Review, 9/1/09
2009-53Prior Authorization Procedures for Anti-Obesity Drugs, 9/1/09
2009-52New Prior Authorization Criteria for Lovaza, 9/1/09
2009-49Introducing the Drug Authorization and Policy Override Center and Prior Authorization Requirements for Synagis®, 9/1/09
2009-46Claims Submitted with Dispense As Written Code "6", 8/1/09
2009-45Prospective Drug Utilization Review Alerts, 8/1/09
2009-36Reimbursement Change for SeniorCare, 6/1/09
2009-34BadgerCare Plus Core Plan for Adults with No Dependent Children-Covered Pharmacy Services, 6/1/09
2009-32Ostomy Supplies Are Covered by BadgerCare Plus Benchmark Plan, 6/1/09
2009-30Pharmacy Coordination of Benefits Clarification for Other Coverage Code 4, 5/1/09
2009-27Procedure Code Updates for Disposable Medical Supplies, 5/1/09
2009-25Clarification of Policy and Reimbursement for Provider-Administered Drugs, 5/1/09
2009-19Swine Flu Antiviral Drugs Are Temporarily Covered by the BadgerCare Plus Benchmark Plan and the BadgerCare Plus Core Plan, 5/1/09
2009-18ForwardHealth Will Require '01' in the Prescriber ID Qualifier Field on Point-of-Sale Real-Time Pharmacy Claims, 4/1/09
2009-12Changes to Pharmacy Coverage Under the BadgerCare Plus Core Plan for Childless Adults Delayed, 4/1/09
2009-10Spring 2009 Preferred Drug List Review, 3/1/09
2009-04Pharmacy Coordination of Benefits Clarifications, 2/1/09
2008
2008-216Provider-Administered Drugs for Members Enrolled in Managed Care Organizations Now Reimbursed by Fee-for-Service, 12/1/08
2008-212Disposable Medical Supplies Covered Under the BadgerCare Plus Core Plan for Childless Adults, 12/1/08
2008-211Durable Medical Equipment Covered Under the BadgerCare Plus Core Plan for Childless Adults, 12/1/08
2008-205Clozapine and Clozapine Management Services Covered Under the BadgerCare Plus Core Plan for Childless Adults, 12/1/08
2008-201Pharmacy Services Covered Under the BadgerCare Plus Core Plan for Childless Adults, 12/1/08
2008-198BadgerCare Plus Core Plan for Childless Adults Training Available for Providers Who Serve Milwaukee General Assistance Medical Program Members, 11/1/08
2008-197Enddating a Prior Authorization Request, 11/1/08
2008-189Reimbursement Changes for Retail Pharmacies, 10/1/08
2008-188Risperdal Requires Brand Medically Necessary Prior Authorization, 10/1/08
2008-187Correction to Prior Authorization Status Table, 10/1/08
2008-185ForwardHealth interChange Edit Will Prevent Inaccurate Reimbursement of Pharmacy Claims, 9/1/08
2008-181Reimbursement Changes for Pharmacy Claims, 9/1/08
2008-180Fall 2008 Preferred Drug List Review, 9/1/08
2008-164ForwardHealth Will No Longer Accept Local Drug Procedure Codes, 9/1/08
2008-150 Planned Effective Dates for Prior Authorization Changes for ForwardHealth interChange Implementation, 8/1/08
2008-146Changes to Coverage of Disposable Medical Supplies Under the BadgerCare Plus Benchmark Plan, Effective with the Implementation of ForwardHealth interchange, 8/1/08
2008-143Reminder: Tamper-Resistant Prescription Pad Requirement for Drug Prescriptions Effective October 1, 2008, 9/1/08
2008-141Expanded Review by ClaimCheck, 8/1/08
2008-126National Drug Codes Required on Claims for Physician-Administered Drugs, 7/1/08
2008-108ForwardHealth Announces Changes to Paper and Electronic Claims Submission for Clozapine Management Services, 7/1/08
2008-105ForwardHealth Announces Changes to Paper and Electronic Claims Submission for Pharmacy Services, 7/1/08
2008-74Changes to Prior Authorization for Enteral Nutrition Products, 6/1/08
2008-73ForwardHealth Announces Changes to Paper and Electronic Claims Submission for Enteral Nutrition Products, 6/1/08
2008-72Changes to Prior Authorization for Disposable Medical Supplies, 6/1/08
2008-71ForwardHealth Announces Changes to Paper and Electronic Claims Submission for Disposable Medical Supplies, 6/1/08
2008-70Changes to Prior Authorization for Durable Medical Equipment, 6/1/08
2008-69ForwardHealth Announces Changes to Paper and Electronic Claims Submission for Durable Medical Equipment, 6/1/08
2008-57Changes to Prior Authorization for Pharmacy Services, 6/1/08
2008-42Changes to STAT-PA for Retail Pharmacy Drugs, 6/1/08
2008-40Brand Medically Necessary Prior Authorization Requirements, 6/1/08
2008-372003 Wisconsin Act 272 Requirements for Billing, 5/1/08
2008-35Changes to Coverage of Disposable Medical Supplies Under the BadgerCare Plus Benchmark Plan, 5/1/08
2008-34Clarification of Coverage and Copayments for Hearing Services and Hearing Instruments, Including Cochlear Implants and Bone-Anchored Hearing Devices, Under the BadgerCare Plus Benchmark Plan, 5/1/08
2008-29Drug Coverage for Members Enrolled in the BadgerCare Plus Benchmark Plan, 4/1/08
2008-26Continuity of Care Transition Period for Pharmacy Services Ending for Managed Care Members, 3/1/08
2008-25Spring 2008 Preferred Drug List Review, 3/1/08
2008-22Reminder: Tamper-Resistant Prescription Pad Requirement Effective April 1, 2008, 3/1/08
2008-18Limited Supply of Free Tamper-Resistant Prescription Pads Now Available, 2/1/08
2008-10Procedure Code Updates for Durable Medical Equipment, 2/1/08
2008-09Procedure Code Updates for Disposable Medical Supplies, 2/1/08
2008-08Temporary Claim Submission Procedures Ending February 4, 2008, for Medicare Part D Dual Eligibles, 1/1/08
2008-07Pharmacy Consolidation for Wisconsin Medicaid and BadgerCare Plus Managed Care Members, 1/1/08
2008-03Clozapine and Clozapine Management Services Under BadgerCare Plus, 1/1/08
2007
2007-112Covered Services and Drugs for the Renewed Family Planning Waiver, 12/1/07
2007-108Pharmacy Services Under BadgerCare Plus, 12/1/07
2007-103Durable Medical Equipment Under BadgerCare Plus, 12/1/07
2007-93Enteral Nutrition Under BadgerCare Plus, 11/1/07
2007-89Disposable Medical Supplies Under BadgerCare Plus, 11/1/07
2007-77Winter 2007 Preferred Drug List Review, 11/1/07
2007-67Tamper-Resistant Prescription Pad Requirement Delayed, 10/1/07
2007-66Fall 2007 Preferred Drug List Review, 9/1/07
2007-65Tamper-Resistant Prescription Pad Requirement, 9/1/07
2007-64Diagnosis Code Restrictions and Quantity Limits for Altabax™, Bactroban®, and Mupirocin, 9/1/07
2007-61Prior Authorization Requirements and Procedure Code Changes for Cochlear Implants and Bone-Anchored Hearing Devices, 9/1/07
2007-59Temporary Claim Submission Procedures Extended to December 31, 2007 for Medicare Part D Dual Eligibles, 9/1/07
2007-56Discontinued Procedure Code for Power-Operated Vehicles (Scooters), 8/1/07
2007-44Modification of Temporary Claim Submission Procedures for Medicare Part D Dual Eligibles, 6/1/07
2007-43Revised Prior Authorization / Preferred Drug List for Hypoglycemics for Adjunct Therapy Form, 6/1/07
2007-42Temporary Claim Submission Procedures Extended to June 30 for Medicare Part D Dual Eligibles, 5/1/07
2007-41Guidelines for Certain Reproductive Health Services, 6/1/07
2007-34Temporary Claim Submission Procedures Extended to May 31 for Medicare Part D Dual Eligibles, 4/1/07
2007-32Temporary Claim Submission Procedures Extended to April 30 for Medicare Part D Dual Eligibles, 3/1/07
2007-31Wisconsin Medicaid Expands 100-Day Supply Drug List, 3/1/07
2007-28Spring 2007 Preferred Drug List Review, 3/1/07
2007-26Medicare Part D Payment Recoupment. 3/1/07
2007-25Temporary Claim Submission Procedures Extended to March 31 for Medicare Part D Dual Eligibles, 2/1/07
2007-24Changes to Immunization CPT Procedure Codes for the Vaccines for Children Program, 2/1/07
2007-22Purchase of Chest Wall Oscillation Systems, 2/1/07
2007-14Emergency Medication Dispensing, 2/1/07
2007-11Temporary Claim Submission Procedures Extended to February 28 for Medicare Part D Dual Eligibles, 1/1/07
2007-07Explanation of Benefits Codes Associated with Drug Claims Available on the Medicaid Web Site, 1/1/07
2007-06Medical Necessity and Claims Submission Requirements for Compression Garments, 1/1/07
2007-01Covered Services and Drugs for the Family Planning Waiver, 1/1/07
2006
2006-101Temporary Claim Submission Procedures Extended to January 31, 2007, for Medicare Part D Dual Eligibles, 12/1/06
2006-100Revised Criteria and Forms for the Prior Authorization / Preferred Drug List, 12/1/06
2006-99Procedure Code Updates for Durable Medical Equipment, 12/1/06
2006-98Procedure Code Updates for Disposable Medical Supplies, 12/1/06
2006-97Medicare Part D True Out-of-Pocket Information for Wisconsin SeniorCare, 12/1/06
2006-95New 1500 Health Insurance Claim Form and Supplemental Instructions, 12/1/06
2006-93Revision to Enteral Nutrition Rates and Nursing Home Policy Reminder, 12/1/06
2006-87Temporary Claim Submission Procedures Extended to December 31 for Medicare Part D Dual Eligibles, 11/1/06
2006-86Fall 2006 Preferred Drug List Revision, 10/1/06
2006-85100-Day Supply Drug Policy and Drug Utilization Review Alert, 10/1/06
2006-77Temporary Claim Submission Procedures Extended to November 15 for Medicare Part D Dual Eligibles, 10/1/06
2006-75Temporary Claim Submission Procedures Extended to October 15 for Medicare Part D Dual Eligibles, 9/1/06
2006-76Fall 2006 Preferred Drug List Review, 9/1/06
2006-72Wisconsin Medicaid Allows Dose Consolidation and Tablet Splitting, 8/1/06
2006-68Facility Reimbursement for Sterilizations Provided to Family Planning Waiver Program Recipients, 8/1/06
2006-67Temporary Claim Submission Procedures Extended to September 15 for Medicare Part D Dual Eligibles, 8/1/06
2006-65SeniorCare Coordination of Benefits with Medicare Part D, 7/1/06
2006-64Temporary Claim Submission Procedures Extended to August 15 for Medicare Part D Dual Eligibles, 7/1/06
2006-53Quantity Limits Apply to Triptans and Pharmaceutical Care Code Expansion, 6/1/06
2006-50Atypical Antipsychotic Drug Class Added to Preferred Drug List and Prior Authorization/Preferred Drug List Forms Revised, 6/1/06
2006-49Temporary Claim Submission Procedures Extended to July 15 for Medicare Part D Dual Eligibles, 6/1/06
2006-47Repayment Process Billing Deadline, 6/1/06
2006-46Coverage of Enteral Nutrition Products, 6/1/06
2006-45Temporary Claim Submission Procedures Extended to June 15 for Medicare Part D Dual Eligibles, 5/1/06
2006-38Temporary Claim Submission Procedures Extended to May 15 for Medicare Part D Dual Eligibles, 4/1/06
2006-37Changes in Blood Count Testing Impacts Clozapine Management Services, 4/1/06
2006-35"A Guide to Obtaining Augmentative Communication Devices and Accessories Through Wisconsin Medicaid" Revised, 4/1/06
2006-34Changes to Repairs and Rentals of Augmentative Communication Devices, 4/1/06
2006-33Revised Preferred Drug List Information, 3/1/06
2006-32Spring 2006 Preferred Drug List Review, 3/1/06
2006-31Temporary Claim Submission Procedures Extended to April 15 for Medicare Part D Dual Eligibles, 3/1/06
2006-19Modifier "CR" Accepted for Catastrophe/Disaster-Related Crossover Claims 3/1/06
2006-18Wisconsin Medicaid Extends Temporary Claims Submission Procedures for Medicare Part D Dual Eligibles, 2/1/06
2006-16Procedure Code Updates for Durable Medical Equipment, 2/1/06
2006-14Procedure Code Updates for Disposable Medical Supplies, 2/1/06
2006-05Coordination of Benefits for SeniorCare Participants Enrolled in Medicare Part D, 1/1/06
2006-04Coordination of Benefits for Medicare Part D Dual Eligibles, 1/1/06
2006-03Temporary Procedures for Submitting Claims for Dual Eligibles, 1/1/06
2005
2005-73New Dispense as Written Code in Point-of-Sale Claims Processing System, 12/1/05
2005-67Maximum Allowable Fee Changes for Prosthetic Devices and Stockings, 11/1/05
2005-64Medicare Drug Coverage for Dual Eligibles, 10/1/05
2005-60Wisconsin Medicaid Enters Multi-State Preferred Drug List and Supplemental Rebate Program, 9/1/05
2005-53New Claim Submission Requirements for Synagis® (palivizumab), 9/1/05
2005-52Life Expectancy and Quantity Limit Changes for Durable Medical Equipment, 9/1/05
2005-49Adaptive Equipment Covered by Wisconsin Medicaid, 9/1/05
2005-44Information About a New Class Added to the Preferred Drug List, 8/1/05
2005-41Maximum Allowable Fee Changes, Modifier Changes, and Documentation Requirements for Power-Operated Vehicles (Scooters), 8/1/05
2005-35Wisconsin Medicaid Adopting HCPCS Code Changes for Enteral Nutrition Products and Allowing Enhanced Reimbursement for Selected Products, 6/1/05
2005-32Expanded Preferred Drug List Information for Prescribers, 6/1/05
2005-31Expanded Preferred Drug List Information for Pharmacy Providers, 6/1/05
2005-28Point-of-Sale Enhancement and Claims Submission Requirement for Recipients with Commercial Health Insurance, 5/1/05
2005-24Expanded Brand Medically Necessary Prior Authorization Criteria, 4/1/05
2005-26Introducing the Revised Prior Authorization/Oxygen Attachment and Clarifying Medicaid Coverage of Oxygen Services, 5/1/05
2005-20Wisconsin Medicaid Coverage of Cochlear and Bone-Anchored Hearing Devices, 3/1/05
2005-19Wisconsin Medicaid Coverage of Vagus Nerve Stimulators, 3/1/05
2005-18New Preferred Drug List Information for Prescribers, 3/1/05
2005-17New Preferred Drug List Information for Dispensing Providers, 3/1/05
2005-09Additional Option for Submitting Prior Authorization Requests Via the Web, 1/1/05
2005-04Procedure Code Updates for Durable Medical Equipment, 1/1/05
2005-03Procedure Code Updates for Disposable Medical Supplies, 1/1/05
2004
2004-93Preferred Drug List Information for Dispensing Providers, 12/1/04
2004-92Preferred Drug List Information for Prescribers, 12/1/04
2004-81Department of Health and Family Services Issues Emergency Order Regarding Influenza Vaccine for the 2004-2005 Season, 10/1/04
2004-78Drug Utilization Review and Pharmaceutical Care Services May Be Submitted in the Same Transaction, 9/1/04
2004-77Prescriber Information on the Wisconsin Medicaid Preferred Drug List, 9/1/04
2004-76Dispensing Provider Information on the Wisconsin Medicaid Preferred Drug List, 9/1/04
2004-75Revised List of Noncovered Durable Medical Equipment and Services, 9/1/04
2004-73Dispensing Providers Reminded of Policy for Drugs Dispensed in a 100-Day Supply, 9/1/04
2004-71Wisconsin Medicaid Reimbursement of Influenza Vaccine for the 2004-2005 Season, 9/1/04
2004-66Billing Requirements for Synagis® (palivizumab), 8/1/04
2004-65Training for New and Current Users of Provider Electronic Solutions (PES) Software Offered in September and October, 8/1/04
2004-63Prescriber Information on Prior Authorization Requirements for Brand Medically Necessary Drugs, 8/1/04
2004-62Pharmacy Information on Prior Authorization Requirements for Brand Medically Necessary Drugs, 8/1/04
2004-59Procedure Code Updates for Incontinence Supplies, 7/1/04
2004-58Submitting Claims in Conjunction with Medicare Drug Discount Cards, 7/1/04
2004-56Revision to Prior Authorization/ Enteral Nutrition Product Attachment Completion Instructions, 7/1/04
2004-55Procedure Code Updates for Durable Medical Equipment, 7/1/04
2004-53Submitting Prior Authorization Requests Via the Web for Selected Services, 6/1/04
2004-51Family Planning Waiver Recipients May Be Eligible for Wisconsin Well Woman Medicaid, 6/1/04
2004-50Introducing the Prior Authorization/Oxygen Attachment, 6/1/04
2004-47Revision to CMS 1500 Claim Form Instructions for Clozapine Management Services, 6/1/04
2004-44Annual SeniorCare Renewal Process Reminder, 6/1/04
2004-41Wisconsin Medicaid Allows Modifier with Procedure Codes for Durable Medical Equipment Repair, 5/1/04
2004-40Training Sessions in July on Submitting Prior Authorization Requests Via the Web, 5/1/04
2004-36Modifier Required for Back-up/Secondary Durable Medical Equipment, 5/1/04
2004-35Prior Authorization Request Submission Available Soon on the Web, 4/1/04
2004-32Procedure Code Updates for Disposable Medical Supplies, 4/1/04
2004-25"A Guide to Obtaining Augmentative Communication Devices and Accessories Through Wisconsin Medicaid" Booklet Available, 4/1/04
2004-20Family Planning Waiver program eligibility period and presumptive eligibility reminders, 3/1/04
2004-17Prior authorization required for brand name selective serotonin reuptake inhibitor drugs, 3/1/04
2004-15Pharmacy real-time claims processing changes and billing reminders, 3/1/04
2004-05HCPCS procedure code update for durable medical equipment, 2/1/04
2004-04Procedure code updates for disposable medical supplies, 2/1/04
2003
2003-166Oxygen-related services coverage revised, 12/1/03
2003-165Limitations to payments for rented durable medical equipment, 12/1/03
2003-164Copayment for disposable medical supplies, 12/1/03
2003-155Procedure code updates for durable medical equipment, 10/1/03
2003-142Wisconsin Medicaid, BadgerCare, and SeniorCare changes for retail pharmacies dispensing drug services, 8/1/03
2003-138Drug coverage limitations for SeniorCare participants, 8/1/03
2003-137Reminder that annual SeniorCare renewal process has started, 8/1/03
2003-136Effective dates for claims submission and prior authorization changes as a result of HIPAA for durable medical equipment, 8/1/03
2003-125Effective dates for claims submission and prior authorization changes as a result of HIPAA for disposable medical supplies, 8/1/03
2003-122Effective dates for claims submission and prior authorization changes as a result of HIPAA for retail pharmacies dispensing drugs and biologics, 8/1/03
2003-109Effective dates for claims submission and prior authorization changes as a result of HIPAA for enteral nutrition products, 8/1/03
2003-102Changes to STAT-PA for orthopedic shoes as a result of HIPAA, 8/1/03
2003-101Changes to STAT-PA for retail pharmacy drugs as a result of HIPAA, 8/1/03
2003-99Changes to paper claims and prior authorization for enteral nutrition products as a result of HIPAA, 8/1/03
2003-98Effective dates for code changes as a result of HIPAA for tuberculosis-related services, 8/1/03
2003-89Effective dates for claims submission changes as a result of HIPAA for clozapine management services, 8/1/03
2003-84Changes to claims and prior authorization for retail pharmacies dispensing drugs and biologics as a result of HIPAA, 8/1/03
2003-68Family Planning Waiver Program policy additions and clarifications, 7/1/03
2003-52Changes to local codes, paper claims, and prior authorization for durable medical equipment as a result of HIPAA, 7/1/03
2003-51Changes to local codes, paper claims, and prior authorization for disposable medical supplies as a result of HIPAA, 7/1/03
2003-48Changes to local codes and paper claims for clozapine management services as a result of HIPAA, 7/1/03
2003-43Wisconsin Medicaid revises policies for oxygen-related services, 6/1/03
2003-34Changes to local codes for tuberculosis-related services as a result of HIPAA, 6/1/03
2003-24Announcing Wisconsin Medicaid's companion document for HIPAA-compliant NCPDP 5.1 billing and reversal transactions, 6/1/03
2003-16Interactive Durable Medical Equipment Index now available, 3/1/03
2003-08Wisconsin Medicaid introduces Guide to the Tuberculosis-Related Services Only Benefit, 2/1/03
2002
2002-68Introducing the Medicaid Family Planning Waiver benefit, 12/1/02
2002-65Wisconsin SeniorCare Coordination of Benefits, 12/1/02
2002-59Disposable medical supplies covered in the home care rate, 11/1/02
2002-55Revised policy requirements and procedure codes for breast pumps, 9/1/02
2002-51Wisconsin Medicaid extends deadline for resubmitting claims for retroactively eligible Medicare recipients, 9/1/02
2002-45SeniorCare information for pharmacies, 8/1/02
2002-43Changes to the Disposable Medical Supplies Index/Maximum Allowable Fee Schedule, 7/1/02
2002-20Prior authorization of durable medical equipment and Medicaid managed care programs, 5/1/02
2002-12Searchable Disposable Medical Supplies Index now available online, 3/1/02
2001
2001-40Durable Medical Equipment Index/Maximum Allowable Fee Schedule changes, 12/1/01
2001-31New telephone hours for pharmacy correspondents, 8/1/01
2001-23Changes to the Disposable Medical Supplies Index, 7/1/01
2001-22Changes to the Durable Medical Equipment Index/Maximum Allowable Fee Schedule, 7/1/01
2001-04Pharmacy Handbook replacement pages, 2/1/01
2001-02Revision of breast pump coverage, 1/1/01
2000
2000-64Wisconsin Medicaid's prospective Drug Utilization Review system alerts, 12/1/00
2000-58Wisconsin Medicaid's prospective Drug Utilization Review system implementation, 11/1/00
2000-49Revised Disposable Medical Supplies Index, 10/1/00
2000-47Introducing Wisconsin Medicaid's Prospective Drug Utilization Review system, 10/1/00
2000-42Changes to the Durable Medical Equipment Index/Maximum Allowable Fee Schedule, 10/1/00
2000-30Products added to Maximum Allowable Cost list, 8/17/00
2000-28Changes in hearing aid battery codes, 8/14/00
2000-19Classification of Birth to 3 and the Individualized Family Service Plan, 7/1/00
2000-17Wheelchairs and durable medical equipment: Changes in maximum allowable fees and life expectancies, 6/1/00
2000-12Re-certification materials due April 30, 2000, 3/1/00
2000-11STAT-PA system will be modified, 3/1/00
1999
99-52Addition of the diagnosis code field to the Electronic Media Claims format, 12/1/99
99-50Important Point of Sale claims reminder, 12/1/99
99-49Prior authorization for Alitretinoin Gel, 12/1/99
99-48Pharmacy policy changes for prior authorization and pharmaceutical care, 11/1/99
99-47STAT-PA notification for fee-for-service pharmacy providers, 11/1/99
99-44Billing and reimbursement for augmentative communication devices, 9/1/99
99-43Augmentative communication prior authorization guidelines, 9/1/99
99-41Ulcer treatment drug and other insurance monitoring changes in Point of Sale pilot counties, 7/1/99
99-38Coverage of an additional type of breast pump and revised clinical guidelines, 8/6/99
99-31Tips for providing orthotics to Medicaid recipients, 8/1/99
99-27Changes to Point of Sale pilot training handouts, 7/1/99
99-25Revised Disposable Medical Supplies Index, 7/1/99
99-22Changes to the DME Index/Maximum Allowable Fee Schedule, 7/1/99
99-20Pharmacy Point of Sale pilot scheduled, 5/1/99
99-15Pharmacy Point of Sale implementation delayed, 3/1/99
99-09Wisconsin Medicaid revises quantity limitations for supplies for Type II diabetics, 3/1/99
99-05Correction to Medicaid�s definition of Type II diabetes for purposes of Medicaid coverage, 2/1/99
99-03Revised DMS Index, 1/1/99
99-01DME Index/Maximum Allowable Fee schedule changes, 1/1/99
1998
98-34Nursing facility drug returns, 12/1/98
98-33Wisconsin Medicaid adopts Medicare's diabetic equipment and supplies policy, 12/1/98
98-32Pharmacy point of sale implementation delayed, 11/1/98
98-31DMS codes change to HCPCS codes, 11/1/98
98-21DME prior authorization, coding, and repairs, 7/01/98
98-17Two percent reimbursement increase for noninstitutional services, 5/28/98
98-10Revised DMS Index, 3/9/98
98-06Durable medical equipment: changes to prior authorization guidelines — Effective March 1, 1998, 2/2/98
98-04Prior authorization required for Two new drugs, 1/15/98
1997
97-44Clozapine and clozapine management changes, 12/12/97
97-40Biennial Budget Increases Reimbursement for Noninstitutional Services — Effective July 1, 1997, 12/3/97
97-27DME Index changes — Effective October 1, 1997, 9/2/97
97-23Revised DMS Index, 8/14/97
97-21Ranitidine is now available generically, 8/4/97
97-11Revised DMS Index, 3/18/97
97-04Revised Administrative Rules: Medically Unnecessary Services — Effective March 1, 1997, 01/30/97
97-03DMS quantity limits, 1/23/97
1996
96-41Revised DMS Index, 11/18/96
96-26Billing for enteral nutrition products, 7/16/96
96-24DME policy clarification: general requirements, wheelchairs and wheelchair accessories, 7/9/96
96-23Clozapine management rate change — Effective for Dates of Service on and after July 1, 1996, 6/28/96
96-21Revised DMS Index, 6/13/96
96-13Certain orthopedic and mismate shoes: changes to prior authorization guidelines, 5/8/96
96-11Positive outcomes may allow enhanced pharmaceutical care dispensing fee, 5/3/96
96-03New tuberculosis (TB) benefit, 3/12/96
96-01Changes to prior authorization guidelines, life expectancy, and maximum allowable fee, 2/16/96
1995
95-13Home health equipment — changes to prior authorization guidelines, 5/17/95
95-11Hospital beds — changes to prior authorization guidelines, 4/10/95
95-03Respiratory care equipment — changes to policy and prior authorization, 2/1/95
1993
MAPB-093-055-HClaim submission limit on drug claims, 12/20/93
 
 
About  |  Contact |  Disclaimer  |  Privacy Notice
Wisconsin Department of Health Services
Production PROD_WIPortal2_M952A__4
Browser Tab ID: 1   -1