Resources for Mental Health and Substance Abuse Providers
Intensive Outpatient Program
Beginning November 1, 2024, providers may enroll with Wisconsin Medicaid as an intensive outpatient program (IOP) provider. For more details, please visit ForwardHealth Update 2024-38, "New Intensive Outpatient Program Benefit."
ForwardHealth Updates
The most recent ForwardHealth Updates are listed below.
ForwardHealth Update 2024-38, “New Intensive Outpatient Program Benefit” (10/22/2024)
Adult Mental Health Day Treatment Providers, Community Support Programs, Crisis Intervention Providers, HealthCheck “Other Services” Providers, Hospital Providers, Outpatient Community Health Centers, Outpatient Mental Health Clinics, Rural Health Clinics, Substance Abuse Clinics, Substance Abuse Day Treatment Providers, Tribal Federally Qualified Heath Clinics, HMOs and Other Managed Care Programs
This Update informed providers of the new IOP benefit, including policies for eligible providers, enrollment, covered and noncovered services, prior authorization (PA), reimbursement, claims submission, member information, and available training for providers that provide IOP services.
Supplemental Materials
Providers are required to document specific information. The materials below meet these documentation requirements. The table below indicates which materials are recommended for use and which materials are required.
Prior Authorization/Intensive Outpatient Treatment Attachment (PA/IOP) This form will be available prior to March 1, 2025.
Form for requesting authorization of intensive outpatient program services (mental health services and/or substance use treatment)
Required
Prior Authorization Request Form (PA/RF), F-11018 (05/2013)
Form for requesting authorization of covered services
ForwardHealth Online Handbook Intensive Outpatient Program Service Area
The following ForwardHealth Online Handbook topics and resources include key content for IOP services. Note: The topics highlighted on this page are linked to address some of the most common provider questions. This is not a complete list of all Online Handbook topics for providers. Providers are still responsible for reviewing the full Intensive Outpatient Program service area of the Online Handbook for complete IOP policy. The Intensive Outpatient Program Online Handbook will be available in March 2025.
Provider Enrollment and Ongoing Responsibilities
Categories of Enrollment, #3969
Handbook Topic
Guidance for enrolling as a Wisconsin Medicaid provider
Examples of Ongoing Responsibilities, #216
Responsibilities of providers
1099 Miscellaneous Forms, #6277
Documentation requirements of providers
A Comprehensive Overview of Provider Rights, #208
Rights of providers
Intermediate Sanctions, #211
Possible consequences for violating program rules and regulations
Provider Identification, #3421
National Provider Identifier requirements
Claim Submission
Accuracy of Claims, #516
Provider responsibility to submit accurate, truthful, and complete claims
1500 Health Insurance Claim Form Completion Instructions, #17797
Provider requirements and instructions for submitting Wisconsin Medicaid and BadgerCare Plus claims
Uploading Claim Attachments Via the Portal, #11677
Guidance on attaching and submitting records with claims
Claim Status, #535
Process for checking the status or adjusting a claim
Explanation of Benefit Codes in the Claim Header and in the Detail Lines, #4822
Messages from ForwardHealth about the status or action taken on a claim, claim detail, adjustment, or adjustment detail
Electronic (Claim Adjustments), #512
Requirements and process for submitting claim adjustments electronically
Options for Electronic Claims Submission
Provider Trainings
Multiple training modules for submitting claims electronically
ForwardHealth Provider Portal Professional Claims User Guide
User Guide
How to submit professional claims electronically
ForwardHealth Portal Uploading Claim Attachments Instruction Sheet
Instruction Sheet
Step-by-step guide for attaching claim records
Additional Resources
Reference Materials
Mark Moody presentation materials: Medicaid Mental Health and Substance Abuse Services (PDF, 82 KB).
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