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2018 ForwardHealth Updates

ForwardHealth Updates — 2018

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

Update NumberForwardHealth Update Topic(s) and release date
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
2018-46 Behavioral Treatment Procedure Code Changes and New Prior Authorization Policy, 12/10/18
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
2018-40 ForwardHealth Holiday Schedule, 11/7/18
2018-39 Naloxone Dispensing Now a Reimbursable Service for Opioid Treatment Programs, 10/22/18
2018-38 Updates to Coordination of Benefits for Community Health Centers, 10/15/18
2018-37 Hospice Reimbursement Rate Changes, 10/12/18
2018-36 Revised Hearing Aid Contract Models and Pricing Effective September 2018, 10/4/18

October 11, 2018: This Update has been revised since its original publication. Two additional hearing aid models and pricing have been added for GN Resound. Revisions on page 9 of Attachment 2 are indicated in red.
2018-35 Reimbursement Rate Increase for Behavioral Treatment Services, 9/25/18
2018-34 Pharmacy Policy Changes Effective September 21, 2018, 9/21/18
2018-33 Removal of Coverage Limitations for Narcotic Treatment Dose Administration, 9/18/18
2018-32 New Coverage and Clarified Prior Authorization Policy for Mobility Devices, 9/13/18
2018-31 Clarification of Tobacco Cessation Copayment Policy, 9/10/18
2018-30 Clarification of the Timely Filing Claims Submission Process, 9/12/18
2018-29 Guidance for Behavioral Treatment for School-Age Youth, 9/10/18
2018-28 Reimbursement Rate Increase for Private Duty Nursing and Pediatric Community Care Services, 9/4/18
2018-27 Clarification of Nursing Home Policy for Private Rooms, 8/16/18
2018-26 New Reimbursement Rates for Services Provided by Ambulatory Surgical Centers, 7/3/18
2018-25 New Outpatient Mental Health Policy Adding Coverage of Mental Health Clinical Consultations for Students, 7/2/18

July 19, 2018: This Update has been revised since its original publication. Information under Covered Services has been changed for the definition of mental health clinical consultation.
2018-24 Information for Eligible Professionals Regarding Program Year 2018 of the Wisconsin Medicaid EHR Incentive Program, 6/25/18
2018-23 Dental Claims Submission Guidelines for Community Health Centers, 6/19/18
2018-22 July 2018 Preferred Drug List Review and Other Pharmacy Policy Changes, 6/15/18
2018-21 Family Care and IRIS Expand in Adams County, 6/13/18
2018-20 Certification and Service Provision for Opioid Treatment Programs, 6/6/18
2018-19 Drug Coverage Limitations for SeniorCare Members, 6/4/18
2018-18 New Electronic Visit Verification Requirement, 5/14/18

May 16, 2018: This Update has been revised since its original publication. The link for the ForwardHealth electronic visit verification dedicated webpage has been revised. The change is indicated in red text.
2018-17 New and Clarified Coverage Policy for Psychosocial Rehabilitation Programs, 5/1/18
2018-16 Clarified Prior Authorization Policy for Home Health and Personal Care Services, 5/1/18
2018-15 New Policy for Outpatient Behavioral Health Services, 4/26/18
2018-14 New Coverage and Prior Authorization Policy for Standing Frames, 4/25/18
2018-13 Former Health Care Connections Benefit Redesigned and Renamed Case Management for Children with Medical Complexity, 4/27/18
2018-12 Clarification of New Reimbursement Methodology for Community Health Centers, 4/2/18
2018-11 New Coverage Policy Regarding Environmental Lead Investigations, 3/16/18
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
2018-09 New Medicare Beneficiary Identifier, 3/1/18
2018-08 New Reimbursement Methodology for Community Health Centers, 2/28/18
2018-07 Clarifications to Nursing Home Policy, 2/22/18
2018-06 Clarification of Increased Reimbursement and Changes to Claims Submission Requirements for Outpatient Behavioral Health Services, 2/15/18
2018-05 Changes to Claims Processing for Members with Medicare Advantage and Medicare Cost Plans, 1/26/18
2018-04 2018 CPT and HCPCS Procedure Code Changes, 1/10/18

January 26, 2018: This Update has been revised since its original publication. The procedure code range for human papillomavirus vaccine listed in Attachment 2 has been revised. See page 11 for the corrected range.
2018-03 Clarification of Therapy Services and Documentation Requirements for School-Aged Members, 1/9/18
2018-02 Updated SSI HMO Enrollment Policy, 1/5/18
2018-01 Rate Increase for Personal Care Services, 1/4/18
 
 
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