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2016 ForwardHealth Updates

ForwardHealth Updates — 2016

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Update NumberForwardHealth Update Topic(s) and release date
2016-55 Reminders for Providers Rendering Services in Rock County for Family Care or IRIS, 12/22/16
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.
2016-53 New Revalidation Application Fee for Provider Organizations and Important Reminders About the Revalidation Process, 11/30/16
2016-52 ForwardHealth Holiday Schedule, 11/21/16
2016-51 Licensed Midwives May Now Become Wisconsin Medicaid Providers, 11/17/16
2016-50 Classic Optical Laboratories, Inc., Will Continue to Provide Eyeglass Materials Under New State Purchase Eyeglass Contract, 11/17/16
2016-49 Hospital Access Payments Discontinued for State Fiscal Year 2016, 10/27/16
2016-48 ForwardHealth Coverage and Prior Authorization Policy for Personal Continuous Glucose Monitoring Devices and Accessories, 10/27/16
2016-47 Hospice Reimbursement Rate Changes, 10/24/16
2016-46 Revised Hearing Aid Contract Models and Pricing Effective September 2016, 10/21/16

January 24, 2017: This Update has been revised since its original publication. Pricing information for one Starkey Laboratories, Inc. hearing aid model (Muse i1600 monaural) has been revised. Revision on page 9 of Attachment 2 is indicated in red.
2016-45 Documentation Requirements for Evaluation and Management Procedure Codes, 10/19/16

November 7, 2016: This Update has been revised since its original publication. Page 2 lists examples of non-verifiable types of phrases for pre-loaded or pre-generated text. The change is indicated in red text.
2016-44 Revised Prior Authorization and Coverage Policy for Bariatric Surgery, 10/19/16
2016-43 Inpatient Hospital Pricing Changing to the All Patient Refined Diagnosis Related Group Classification System, 10/11/16
2016-42 Information for Eligible Hospitals Regarding Program Year 2016 of the Wisconsin Medicaid Electronic Health Record Incentive Program, 10/5/16

January 4, 2017: Information under the "Electronic Health Record Reporting Periods for Meaningful Use" heading has been revised in response to the CMS Hospital Outpatient Prospective Payment System final rule. The change is indicated in red text.
2016-41 Information for Eligible Professionals Regarding Program Year 2016 of the Wisconsin Medicaid Electronic Health Record Incentive Program, 10/5/16

January 4, 2017: Information under the "Electronic Health Record Reporting Periods" heading has been revised in response to the CMS Hospital Outpatient Prospective Payment System final rule. The change is indicated in red text.
May 16, 2017: Federally Qualified Health Centers and Rural Health Clinics were added to the "To" list of providers.
2016-40 Changes to the Express Enrollment Process, 9/30/16
2016-39 Medicaid Program Integrity Education Resources Available, Including Continuing Education Courses, 9/26/16
2016-38 Targeted Reimbursement Rate Increase for Certain Dental Services Provided in Four Counties, 9/16/16

October 7, 2016: This Update has been revised since its original publication. The list of procedure codes in the Attachment on page 5 have been revised. Procedure codes D3221 and D7140 have been added and procedure codes D3220 and D7111 have been removed. The changes are indicated in red text.
2016-37 Eligibility Information Immediately Available in interChange for Real-Time Eligibility Determinations, 9/16/16
2016-36 Upcoming Trainings for the All Patient Refined Diagnosis Related Group System, 9/16/16
2016-35 Changes to Billing Policy for Chiropractic Services, 8/30/16

November 11, 2016: This Update has been revised since its original publication. Page 2 lists examples of non-verifiable types of phrases for pre-loaded or pre-generated text. The change is indicated in red text.
2016-34 New and Clarified Policy for the Behavioral Treatment Benefit, 8/3/16
2016-33 New Coverage and Prior Authorization Policy for Positioning Seats for Use in Motor Vehicles and at Home, 8/3/16
2016-32 Revised Prior Authorization Forms and Changes to Pharmacy Policies for Hepatitis C Agents Effective August 1, 2016, 7/29/16
2016-31 Policy Regarding Submission of Hospital Claims for Births, 7/28/16
2016-30 Pharmacy Policy Changes Effective August 1, 2016, 7/18/16
2016-29 Ambulatory Surgical Center Access Payments Discontinued for Fiscal Year 2016, 7/14/16
2016-28 Prior Authorization No Longer Required for Cochlear Implant and Bone-Anchored Hearing Device Implant Surgeries, 7/13/16
2016-27 Managed Care Program Length-of-Stay Policy Change for Institutions for Mental Disease, 7/5/16
2016-26 Implementation of the All Patient Refined Diagnosis Related Groups Classification System, 6/30/16
2016-25 Information for Eligible Professionals Regarding Program Year 2016 of the Wisconsin Medicaid Electronic Health Record Incentive Program, 6/24/16
2016-24 New Coverage and Prior Authorization Policy for Gait Trainers, 6/22/16
2016-23 Reporting Other Health Insurance Information on Dental Claims, 6/24/16
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
2016-20 Prior Authorization Will No Longer Be Required for OnabotulinumtoxinA (Botox®) When Used to Treat Chronic Migraines, 5/27/16
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
2016-17 New Fingerprinting and Criminal Background Check Screening Requirements Due to the Affordable Care Act, 5/16/16
2016-16 Changes to Coverage Policy for Testing for Drugs of Abuse, 4/18/16
2016-15 Information for Eligible Professionals Regarding Changes to the Wisconsin Medicaid Electronic Health Record Incentive Program for Program Year 2015, 4/28/16

May 16, 2017: This Update has been revised since its original publication. Federally Qualified Health Centers and Rural Health Clinics were added to the "To" list of providers.
2016-14 Changes to Pharmacy Policies for Hepatitis C Agents, 4/13/16
2016-13 Reminder of Correct Billing Process for Long-Term Care Services, 4/1/16
2016-12 Changes to Prospective Drug Utilization Review Alerts, 4/1/16
2016-11 2016 Procedure Code Changes for Dental Services, 3/9/16
2016-10 Reminder: Exhausting Other Health Insurance Sources Before Submitting Nursing Home Claims to ForwardHealth, 3/7/16
2016-09 Prior Authorization Criteria and Coverage Policy for Prophylactic Mastectomies, 3/3/16
2016-08 Prior Authorization Criteria and Coverage Policy for Gynecomastia Surgery, 3/3/16
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
2016-05 2016 CPT and HCPCS Procedure Code Changes, 1/29/16
2016-04 New and Clarified Policy Regarding Submission of Prior Authorization Requests and Claims for Hearing Instruments, 1/27/16
2016-03 ForwardHealth Expanding Member Eligibility for HIV/AIDS Care Coordination Benefit, 1/14/16
2016-02 Changes to Claims Submission Requirements for Outpatient Hospital Services, 1/7/16
2016-01 Clarifications to Nursing Home Bedhold Policy, 1/22/16
 
 
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