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:

• Children's Long-Term Support: Third Party Administration Transition for Providers
• Children's Long-Term Support: Third Party Administration Transition for County Waiver Agencies

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 accessed 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, trainings, 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:

• February 2025: Provider training
• February–July 2025: Provider testing
• April 2025: Provider refresher training
• April 28, 2025: Claims submission go live
• May 5, 2025: Claims processing go live

Testing

Existing CLTS providers received 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.

Submission Sandbox Testing and Refresher Training Dates

• March 14, 2025: Providers interested in participating in the Submission Sandbox should email the Gainwell Technologies CLTS Operations Team at cltsoperations@gainwelltechnologies.com.
• March 19, 2025: The Submission Sandbox testing environment opens for providers and CWAs.
• April 15, 2025: Live refresher trainings begin to guide providers and CWAs through the Submission Sandbox.
• April 24, 2025: Live refresher trainings conclude.

Training Resources for the Submission Sandbox

Written and video presentations of the trainings are available:

• Children’s Long-Term Support Provider Claims Training, presentation and video
• Children’s Long Term Care Program Claims and PA Refresher Training for CWA’s video

Resources

• Providers can email dhscltsproviderrelations@dhs.wisconsin.gov with questions about the upcoming TPA transition.
• The ForwardHealth Catalog of Trainings and Educational Resources for Providers and Other Stakeholders webpage has trainings and resources to introduce providers to the Portal under the ForwardHealth Portal Basics/Navigation drop-down menu.
• The DHS Children's Long-Term Support (CLTS) Program: Information for Providers webpage has information about becoming a CLTS Program provider, payment rates, getting paid, and how to stay up to date about the CLTS Program.
• Refer to the FAQs About Children’s Long-Term Support Program: Third-Party Administration Transition (PDF) for answers to common CLTS provider questions. (Updated 04/28/2025)
• Prepare for the claims payer transition with the Children’s Long-Term Support Program TPA Transition: Provider Readiness Checklist (PDF) (02/2025).
• Learn about where to submit claims for CLTS Program services with the Children’s Long-Term Support Program and Electronic Data Interchange Guidance (PDF).