Resources for Mental Health and Substance Abuse Providers

Welcome » May 1, 2025 1:43 AM

Intensive Outpatient Program

Beginning November 1, 2024, providers may enroll with Wisconsin Medicaid as an intensive outpatient program (IOP) provider. 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.

Update and Release Date	Affected Providers	Description of Policy Change
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.

Title of Form and Number	Description of Form	Recommended or Required?
Prior Authorization/Intensive Outpatient Treatment Attachment (PA/IOP), F-03325 (02/2025)	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	Required

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

Title	ForwardHealth Resource	Description of Content
Categories of Enrollment, #3969	Handbook Topic	Guidance for enrolling as a Wisconsin Medicaid provider
Examples of Ongoing Responsibilities, #216	Handbook Topic	Responsibilities of providers
1099 Miscellaneous Forms, #6277	Handbook Topic	Documentation requirements of providers
A Comprehensive Overview of Provider Rights, #208	Handbook Topic	Rights of providers
Intermediate Sanctions, #211	Handbook Topic	Possible consequences for violating program rules and regulations
Provider Identification, #3421	Handbook Topic	National Provider Identifier requirements

Claim Submission

Title	ForwardHealth Resource	Description
Accuracy of Claims, #516	Handbook Topic	Provider responsibility to submit accurate, truthful, and complete claims
1500 Health Insurance Claim Form Completion Instructions, #17797	Handbook Topic	Provider requirements and instructions for submitting Wisconsin Medicaid and BadgerCare Plus claims
Uploading Claim Attachments Via the Portal, #11677	Handbook Topic	Guidance on attaching and submitting records with claims
Claim Status, #535	Handbook Topic	Process for checking the status or adjusting a claim
Explanation of Benefit Codes in the Claim Header and in the Detail Lines, #4822	Handbook Topic	Messages from ForwardHealth about the status or action taken on a claim, claim detail, adjustment, or adjustment detail
Electronic (Claim Adjustments), #512	Handbook Topic	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

Title	ForwardHealth Resource	Description
Assessment and Treatment Planning, #23743	Handbook Topic	Guidance on clinical assessment, treatment plan, discharge and continuing care plan, and qualified clinicians
Program Requirements for Intensive Outpatient Program Services, #23746	Handbook Topic	IOP program requirements for covered services, member eligibility, and medication-assisted treatment
Separately Billable Services, #23745	Handbook Topic	Guidance on services not included in the bundled assessment and reimbursement rate
Treatment Services, #23747	Handbook Topic	Guidance on IOP treatment services
Coordination Between Comprehensive Community Services and Intensive Outpatient Program Treatment, #23744	Handbook Topic	Guidance for IOP treatment when members receive comprehensive community services

Prior Authorization

Title	ForwardHealth Resource	Description
Prior Authorization Requirements for Initial Requests, #23754	Handbook Topic	Guidance on forms and process for submitting an initial prior authorization request
Prior Authorization Requirements for Requests to Extend Treatment, #23749	Handbook Topic	Process for requesting a prior authorization amendment to extend IOP treatment beyond the initial authorization
Attachments, #23753	Handbook Topic	Guidance on forms that must accompany a prior authorization request for IOP services
Real-Time Review Through the ForwardHealth Portal, #23750	Handbook Topic	Process and guidance on submitting PA requests for IOP services through the Portal including initial PA requests, attestation of criteria for substance use treatment PA requests, and criteria for real-time review or approval of the PA request
Approval Criteria for Initial Prior Authorization Requests, #23751	Handbook Topic	Guidance on criteria that must be met before submitting an initial prior authorization request

Additional Resources

For policy and billing questions—Provider Services at 800-947-9627
For ForwardHealth Portal accounts, functions, and password questions—ForwardHealth Portal Helpdesk at 866-908-1363
For ForwardHealth members who have questions—Member Services at 800-362-3002 (member use only)

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