wisconsin.gov HomeState AgenciesDepartment of Health Services
Welcome  » February 16, 2025 6:44 AM
Login
Search

Children's Long-Term Support Program: Third-Party Administration Transition

The Children’s Long-Term Support (CLTS) Program helps children with disabilities and their families through supports and services that help children grow and live their best lives in their homes and communities.

New Claims Payer in 2025

The Wisconsin Department of Health Services (DHS) is preparing to change the claims payer for the CLTS Program. Wisconsin Physicians Service (WPS) is the current third-party administrator (TPA). In 2025, DHS will transition the CLTS Program claims processing to Gainwell Technologies, which also serves as the fiscal agent for ForwardHealth. Providers will need to understand what will change, what trainings will be available, and when the transition will happen.

DHS created two temporary webpages to provide more information on processes with Gainwell after the transition:

Find information on current processes with WPS.

What will change?

CLTS providers and county waiver agencies (CWAs) will no longer use the WPS Portal. Instead, they will use the ForwardHealth Portal (the Portal) to submit claims and view claims history or prior authorizations (PAs). Here are some important notes about how the Portal will work:

  • Claims and PA history will be viewable on the Portal.
  • Only Health Insurance Portability and Accountability Act of 1996 (HIPAA)-standard claim submission methods will be accepted. This means spreadsheet submissions will no longer be allowed. Providers can use the Portal to:
    • Submit claims in a HIPAA-compliant electronic format.
    • Create a claim from a PA.
    • Copy and modify an existing paid claim instead of entering a new claim.

How can I learn more?

DHS wants to make sure this transition is a smooth process for CLTS Program providers.

DHS and Gainwell hosted several webinars, forums, and system demonstrations about the transition. Providers and CWAs may view recordings and presentations on the webpages listed above by scrolling to the Past Events drop-down menu.

What’s the timeline?

CLTS Program providers need to begin using Gainwell in May 2025. Here is the full transition timeline:

  • Provider training: February 2025
  • Provider testing: February–May 2025
  • Go live claims submission: April 28, 2025
  • Go live claims processing: May 5, 2025
  • Continued provider testing if needed: May–July 2025

Testing

Existing CLTS providers will receive a welcome letter and a PIN letter in January 2025 that contain a new Medicaid ID and PIN. In addition to using the Medicaid ID and PIN to log in to the Portal, CLTS providers may also use the submission sandbox to practice submitting claims to Gainwell for CLTS services. Providers interested in participating in the Submission Sandbox should email the Gainwell Technologies CLTS Operations Team at cltsoperations@gainwelltechnologies.com by February 7.

Providers may refer to the ForwardHealth Provider Portal Account User Guide, P-00952 (PDF) for guidance on how to access the Portal.

CWAs may refer to the Children’s Long-Term Support Waiver Agency Portal User Guide (PDF) for guidance on how to access the Portal.

Resources

 
 
About  |  Contact |  Disclaimer  |  Privacy Notice
Wisconsin Department of Health Services
Production PROD_WIPortal2_M992B__7
Browser Tab ID: 1   -1