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:
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:
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
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