Intensive Outpatient Program
Since November 1, 2024, providers have been able to enroll with Wisconsin Medicaid as intensive outpatient program (IOP) providers. For more details, visit the Intensive Outpatient Program service area of the ForwardHealth Online Handbook.
Intensive Outpatient Program Trainings
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 Health Centers, Community Support Programs, Crisis Intervention Providers, HealthCheck Other Services Providers, Hospital Providers, Outpatient Mental Health Clinics, Outpatient Substance Abuse Clinics, Rural Health 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. Providers can search for forms by entering the form number in the Keyword or Form Number field on the Forms page of the ForwardHealth Portal (the Portal)
Prior Authorization/Intensive Outpatient Treatment Attachment (PA/IOP), F-03325 (02/2025)
Form for requesting authorization of IOP 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.
Provider Enrollment and Ongoing Responsibilities
Categories of Enrollment, #3969
Online 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
Covered and Noncovered Services
Prior Authorization
Additional Resources
Continuing Care and Concurrent Service Resources
Beginning December 1, 2025, ForwardHealth expanded the availability of continuing care and concurrent service options to providers administering mental health and substance abuse treatment, per Wis. Admin. Code § DHS 75.
Continuing Care
The Wisconsin Department of Health Services (DHS) defines “continuing care” as treatment for such members who plan to continue contact with their provider, either at agreed-upon intervals or on an unplanned basis based on unexpected needs, without completing a new clinical assessment, intake or treatment plan.
Some members who have been discharged following the completion of a course of outpatient SUD or integrated treatment may be eligible for continuing care, which is a new utilization flexibility.
This flexibility is available to agency providers certified under Wis. Admin. Code §§ DHS 75.49 and 75.50 within the outpatient substance abuse benefit and select procedure codes within the outpatient mental health benefit.
Online Handbook Topics
Continuing Care, #23943
Continuing care defined as a “utilization flexibility”
Procedure Codes, #5807
Outpatient substance abuse treatment procedure codes
Procedure Codes, #6123
Outpatient mental health procedure codes, including the new continuing care billing modifier
Modifiers, #6218
Outpatient mental health modifiers
Covered Services, #5800
Continuing care definition and assessment requirements
Concurrent Services
Allowed Concurrent Outpatient Mental Health and Substance Use Disorder Services
DHS defines "concurrent services" as treatment by two distinct and appropriately credentialed providers for a member who has multiple substance use needs or co-occurring substance use and mental health needs.
Eligibility Criteria
Substance use services or co-occurring substance use and mental health services may be provided concurrently when they are considered medically necessary, non-duplicative, and appropriate. Providers of concurrent services must demonstrate that both services are diagnostically appropriate for the member and coordinate with each other on the member's treatment and ongoing needs.
Providers aren’t required to get PA for a member to receive concurrent behavioral health services. However, if one or more of the services typically require PA, providers must request PA for the service according to the policy for that service.
Coverage Policy
The concurrent service policy also impacts:
Concurrent Services, #23944
Concurrent services mental health and substance use treatment service definition and criteria
Concurrent Adult Mental Health Day Treatment Services, #5917
Program requirements for adult mental health day treatment services concurrent with other mental health and substance abuse services
Concurrent Mental Health Prior Authorizations, #6497
PA requirements for concurrent mental health
Expectations and Documentation Requirements for Collaborating Providers, #21337
Provider documentation requirements for the provision of concurrent services
Coverage of Outpatient Mental Health Services Concurrent With Other Mental Health or Substance Abuse Services, #6097
Program requirements for outpatient mental health services concurrent with other mental health and substance abuse services, including residential SUD program
Concurrent Behavioral Treatment and Behavioral Health Services, #19019
Provider responsibilities for delivery concurrent behavioral treatment and behavioral health services
Point-of-Care Drug Testing, #22937
Point-of-care drug testing for SUD treatment
Coordination Between Comprehensive Community Services and Residential Substance Use Disorder Treatment, #22997
Coverage requirements and exceptions for the concurrent use of CCS and residential SUD programs
Procedure Codes, #23741
IOP and point-of-care drug testing procedure codes
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