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2011 ForwardHealth Updates

ForwardHealth Updates — 2011

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Update NumberForwardHealth Update Topic(s) and release date
2011-88Enteral Nutrition Product Criteria for Coverage and Other Policy Information, 12/28/11
2011-87Changes to Fees Charged to Members for Copies of Health Care Records, 12/21/11
2011-86Change to Provider Requirement for Child Care Coordination Services in the City of Racine, 12/21/11
2011-852011 Rate Changes for School-Based Services, 12/20/11
2011-84January 2012 Preferred Drug List Review and Other Pharmacy Policy Changes, 12/20/11
2011-83Professional Claims Billed by Pathology or Radiology Physician Group Providers Will Require Rendering Provider's National Provider Identifier, 12/20/11
2011-82ForwardHealth Making Changes to Explanation of Benefits Information on Provider Portal, 12/15/11
2011-81ForwardHealth Training Opportunities and Resources, 12/2/11
2011-80New Procedure Codes for Mileage for Transports by Ambulance Providers, 12/2/11
2011-79New Prior Authorization Criteria for Wearable Cardioverter Defibrillator, 11/22/11
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
2011-76Reminder: Claims for Outpatient Hospital Therapy Services Must Be Submitted Using a Professional Claim, 11/22/11
2011-75Hospital and Ambulatory Surgical Center Access Payments Discontinued for Fiscal Year 2011, 11/17/11
2011-74Cost Sharing Clarification for Medicaid, BadgerCare Plus Standard Plan, and BadgerCare Plus Benchmark Plan, 11/2/11
2011-73Cost Share Exemptions for Tribal Members, 11/2/11
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
2011-71Prescription No Longer Required to Initiate Certain Mental Health and Substance Abuse Treatment Services, 11/4/11

December 21, 2011: This Update has been revised since its original publication. The list of benefits that still require a prescription to initiate services has been revised as of December 21, 2011. Community Recovery Services do not require a prescription to initiate treatment. The change to the Update is indicated in red.
2011-70Hospice Reimbursement Rate Changes, 11/1/11
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.
2011-68Additional Information and Clarifications Regarding the Wisconsin Medicaid Electronic Health Record Incentive Program, 10/31/11

This Update has been revised since its original publication. The November and December dates for an Eligible Hospital's fiscal year in Attachment 2 have changed since original publication. For more information, refer to page 7 of this Update or to the Determining the Payment Year for Eligible Hospitals topic (topic #12517) in the EHR Incentive Program section, Financial Information chapter of the Online Handbook.
2011-67ForwardHealth Holiday Schedule, 10/18/11
2011-66Change to Non-emergency Medical Transportation Services Appeals Process, 10/10/11
2011-65New Prior Authorization Criteria for Gynecomastia Surgery, 10/10/11
2011-64New Prior Authorization Criteria for Pectus Excavatum/Carinatum Surgery, 10/10/11
2011-63New Reimbursement Policies for Influenza Immunizations Administered by Pharmacy Providers, 10/21/11
2011-622011 Rate Changes for Services Receiving Only Federal Funds, 10/18/11
2011-61Revised Hearing Aid Contract Models and Pricing Effective September 2011, 10/4/11

This Update has been revised since its original publication. The address for Oticon, Inc., in Attachment 1 has been updated as of January 9, 2012.
2011-60Reminder: Reimbursement for Laboratory Procedures Requires Valid CLIA Certification, 10/3/11
2011-59Effective Dates for the Implementation of HIPAA Version 5010 Standard and the NCPDP Telecommunication Standard Version D.0, 9/23/11
2011-58Announcing Provider Electronic Solutions Software Version 3.0, 9/20/11
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
2011-55Rate Changes for Case Management Services, 9/22/11
2011-54New Reimbursement Methodologies for Drugs and Diabetic Supplies, 9/20/11
2011-53Revisions to UB-04 Claim Form Instructions Resulting from HIPAA ASC X12 Version 5010 Implementation, 9/14/11
2011-52Revisions to 1500 Health Insurance Claim Form Instructions Resulting from HIPAA ASC X12 Version 5010 Implementation, 9/14/11
2011-51National Provider Identifier Subpart Policy for Hospitals, 9/1/11
2011-50Clarification of Sterilization Policy Regarding Retroactive Eligibility, 8/29/11
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
2011-47Providers May Change or Add Taxonomy Codes, 8/24/11
2011-46Policy for Provider Group Practice Certification, 8/24/11
2011-45Changes to Claim Submission and Reimbursement Policy for End-Stage Renal Disease Services, 8/24/11

May 31, 2012: This Update has been revised since its original publication. An interim per diem rate of $214.60 was implemented in November 2011 retroactive to September 2011 for end-stage renal disease services. The per diem rate is indicated in red on page 3 of the Update.
2011-44Changes to Bariatric Surgery Prior Authorization Guidelines, 8/22/11
2011-43Hospitals Will Receive Performance-Based Payments for State Fiscal Year 2011, 8/17/11
2011-42Change to ForwardHealth Update 2011-32 Regarding Claims for Home Health, Personal Care, and Private Duty Nursing Services, 8/10/11
2011-41Change in Reimbursement for Inpatient Hospital Services Covered by Medicare Part A, 7/28/11
2011-40The Wisconsin Medicaid Electronic Health Record Incentive Program for Eligible Professionals, 7/25/11
2011-39The Wisconsin Medicaid Electronic Health Record Incentive Program for Eligible Hospitals, 7/26/11

August 18, 2011: The Wisconsin Medicaid EHR Incentive Program will not be communicating qualification under patient volume requirements through secure Portal messaging. Page 3 has been revised to reflect this change. When completing the Wisconsin Medicaid EHR Incentive Program application, Eligible Hospitals will need to enter a "zero" in the space labeled "Other Medicaid Discharges (Other Numerator)" instead of a blank. Page 4 has been revised to reflect this change.
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, 6/28/11

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.
2011-35ForwardHealth Clarifies Contract and Noncontract Eyeglass Policy and Ends a Prior Authorization Requirement for Certain Contract Lenses, 6/28/11
2011-34Announcing HIPAA ASC X12 Version 5010 Companion Guides, NCPDP Version D.0 Payer Sheet, and Testing Information, 6/24/11

September 23, 2011: The dual processing period for electronic transactions has changed to October 16 through December 31, 2011. Pages 2 and 3 are shown to reflect this change.
July 19, 2011: The date trading partners may start compliance testing has changed to October 15, 2011. As of September 23, 2011, this date has changed to October 16, 2011. Page 2 has been revised to reflect this change.
2011-33Announcing New Companion Guides for the 820 Payroll Deducted and Other Group Premium Payment for Insurance Products and the 834 Benefit Enrollment and Maintenance, 6/24/11
2011-32Reminder: Claims for Home Health, Personal Care, and Private Duty Nursing Services Must Be Submitted as Institutional Claims, 6/29/11
2011-31Wisconsin Well Woman Program Training Available, 6/29/11
2011-30New Maximum Allowable Fees for Certain Prostheses, 6/7/11
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
2011-26Changes to Newborn Reporting, 4/26/11

On June 16, 2011, the Newborn Report (F-1165) has been revised since it was originally published in this ForwardHealth Update. The revised form dated 06/11 is in the Attachment of this Update.
2011-25Changes to Personal Care Agency Certification Rules and Clarification of Registered Nurse Supervisor Duties, 4/29/11
2011-24New Non-emergency Medical Transportation Management System for Wisconsin Medicaid and BadgerCare Plus Members, 4/15/11

On May 3, 2011, the TTY telephone number on page 2 and 4 of the Member Update and Attachment 3 was revised. All changes are indicated in red text.
On April 26, 2011, this Update was revised since its original publication, as indicated in red text on pages 1, 2, 11 and 13.
2011-23Electronic Health Record Incentive Program Information Sessions Offered for Providers, Hospitals, and Staff, 4/11/11

The list of affected providers has been revised as of April 19, 2011. Advanced Practice Nurse Prescribers with Psychiatric Specialty, Dental Groups and Rural Health Clinics are eligible health care providers for this program and have been added to the Update. Optometrists were incorrectly listed as being eligible health care providers. All changes to the Update are indicated in red.
2011-22Photographs Mailed to ForwardHealth as Additional Supporting Clinical Documentation for Prior Authorization Requests Will No Longer Be Returned to Providers, 4/11/11
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
2011-19Uploading Claim Attachments Via the Portal, 4/14/11
2011-18BadgerCare Plus Basic Plan New Enrollment Ending, 3/1/11
2011-17The ForwardHealth Update Summary Will Only Be Available on the ForwardHealth Portal, 3/1/11
2011-16Remittance Advice Modified to Reflect Changes to Claim Adjustment Calculations, 3/1/11
2011-15Changes to the Revenue Accommodation Billing Code for Nursing Home Residents, 3/1/11
2011-14Nursing Home Rate Communications Available on the ForwardHealth Portal, 3/1/11
2011-13Important Information About the National Correct Coding Initiative, 3/1/11
2011-12Providers May Upload Prior Authorization Attachments and Additional Clinical Supporting Documentation for Prior Authorization Requests Submitted Via the Portal, 3/1/11
2011-11New Medicaid Non-Emergency Medical Transportation Management System, 2/1/11
2011-10New Laboratory Procedure Code Reimbursable for Tuberculosis-Related Services-Only Benefit, 2/1/11
2011-09Introducing Two New Reports for Compound and Noncompound Drug Claims, 2/1/11
2011-08Hospital Access Payments Discontinued for Fiscal Year 2010, 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
2011-05Changes to Newborn Reporting, 1/1/11
2011-04Changes to the Pharmacy Services Lock-In Program, 1/1/11
2011-03New Birth to 3 Form Available for Use with Prior Authorization Requests for Therapy Services Outside the Birth to 3 Program, 1/1/11
2011-02Changes to the Personal Care Screening Tool and Related Policy Clarifications, 1/1/11
2011-01Discretionary Variances for Registered Nurse Supervisory Visits and Discretionary Waivers of Qualifications for Registered Nurse Supervisors Discontinued, 1/1/11
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