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Children's Long-Term Support Program: Claims Processing 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 Processor in 2025

The Wisconsin Department of Health Services (DHS) has transitioned the state’s claims processing for CLTS Program prior authorizations (PAs) and claims from Wisconsin Physicians Service (WPS) to Gainwell Technologies using the ForwardHealth Portal (the Portal).

DHS created two temporary webpages to provide more information on ForwardHealth processes:

What changed?

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

  • CLTS providers can access claims and PA history on the Portal.
  • ForwardHealth only accepts Health Insurance Portability and Accountability Act of 1996 (HIPAA)-standard claim submission methods. This means ForwardHealth does not allow spreadsheet submissions. 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?

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

Transition Timeline

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 containing 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 through July 2025 to practice submitting claims to ForwardHealth for CLTS services.

Training Resources

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

User Guide Description Who should use this resource?
Children’s Long-Term Support Waiver Agency Portal User Guide (PDF) Guidance on how to access the Portal CWAs
Children’s Long-Term Support Waiver Agency Prior Authorization User Guide (PDF) Guidance on how to submit PAs CWAs
ForwardHealth Provider Portal Account User Guide, P-00952 (PDF) Guidance on how to access the Portal Providers
ForwardHealth Provider Portal Institutional Claims User Guide, P-00970 (PDF) Guidance on how to submit institutional claims on the Portal CWAs, Providers
ForwardHealth Provider Portal Professional Claims User Guide, P-00970A (PDF) Guidance on how to submit professional claims on the Portal CWAs, Providers

Website Description Who should use this resource?
ForwardHealth Catalog of Trainings and Educational Resources for Providers and Other Stakeholders Trainings and resources to introduce providers to the Portal under the ForwardHealth Portal Basics/Navigation drop-down menu Providers
DHS Children's Long-Term Support (CLTS) Program: Information for Providers Information about becoming a CLTS Program provider, payment rates, getting paid, and how to stay up to date about the CLTS Program Providers

Factsheet Description Who should use this resource?
Children’s Long-Term Support Program Place of Service Codes (PDF) Table of place of service codes for CLTS services CWAs, Providers
FAQs About Children’s Long-Term Support Program: Claims Processor Transition (PDF) Answers to common CLTS CWA and provider questions CWAs, Providers
Children’s Long-Term Support Program and Electronic Data Interchange Guidance (PDF) Guidance about where to submit claims for CLTS Program services Providers
Children’s Long-Term Support (CLTS) Program Benefit Code Crosswalk (P-02283) Guidance on codes and modifiers for CLTS services CWAs, Providers
Children’s Long-Term Support Waiver (CLTS) Statewide Uniform Rate Schedule (P-02184) Rates on the CLTS rate schedule represent the maximum amounts that can be paid for each service unit without an outlier rate. CWAs, Providers
Create a Prior Authorization Bulk Report (PDF) Guidance on how to create a report that shows information about more than one PA at a time Providers
Payments for Children’s Long-Term Support Program Services (PDF) Information about the two payment options for CLTS Program services Providers
Children's Long-Term Support Program Provider Email Resources (PDF) Guidance on the most appropriate email resource for provider CLTS Program questions Providers
Children's Long-Term Support Program County Waiver Agency Email Resources (PDF) Guidance on the most appropriate email resource for CWA CLTS Program questions CWAs

County Waiver Agency Prior Authorization Error Checklist (PDF)

Checklist for CWAs to help resolve PA errors

CWAs

Children’s Long-Term Support Program: Multiple Dates of Service on a Claim (PDF)

Guidance for billing multiple dates of service, also known as span billing, on a claim for CLTS services

CWAs, Providers

Form Description Who should use this resource?

Children's Long-Term Support (CLTS) Waiver Program Timely Filing Claim Exception Request, F-03334

· Use this form if ForwardHealth denied your claim for a timely filing denial reason and you want to request an exception to the CLTS Waiver Program’s timely filing policy

· Click the form title link to go to the Official DHS Forms Library page. Enter F-03334 in the Search Forms field. Complete either the PDF or Word version of the form and submit it to the address listed on the form.

CWAs, Providers
 
 
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