Resources for Dental Service Providers in Brown, Marathon, Polk, and Racine Counties

In accordance with a provision of the 2015-17 biennial state budget (2015 Wisconsin Act 55), ForwardHealth implemented increased reimbursement rates for pediatric dental care and certain adult dental services rendered in Brown, Marathon, Polk, and Racine counties for dates of service (DOS) on and after October 1, 2016. These counties were identified in the 2015-17 biennial state budget.

ForwardHealth has published the September 2016 ForwardHealth Update (2016-38), titled "Targeted Reimbursement Rate Increase for Certain Dental Services Provided in Four Counties," with detailed information. Note: Update 2016-38 has been revised since its original publication.

The reimbursement rate increase applies to all Medicaid-enrolled provider types eligible to render dental services in a target county; however, the reimbursement rate increase does not apply to dental services billed through a federally qualified health center. The reimbursement rate applies to services provided fee-for-service and via managed care.

Maximum Allowable Fees

ForwardHealth establishes maximum allowable fees for the reimbursement of most covered services. Targeted reimbursement rate maximum allowable fees (10/7/2016) are established for DOS on and after October 1, 2016. These fees are not part of ForwardHealth’s interactive maximum allowable fee schedule and are subject to change.

Provider Enrollment Resources

Providers are required to be enrolled in Wisconsin Medicaid as described in DHS 105 in order to be eligible to receive reimbursement for covered services. Providers in target counties who are already Medicaid-enrolled will not need to re-enroll to be eligible for the increased reimbursement rates. For enrolling providers, refer to the following ForwardHealth Portal pages for detailed enrollment information:

• Information for Specific Provider Types – Providers may scroll to their provider type in the drop-down menu to view provider-specific eligibility criteria.
• To Start a New Medicaid Enrollment – Providers may start or continue a Medicaid enrollment application.
• Enrollment Tracking Search Tool – Providers may track the status of their enrollment application by entering their application tracking number (ATN) in the Enrollment Tracking Search on the Portal.
• ForwardHealth Provider Portal Account User Guide – Once enrolled, providers will be required to establish their ForwardHealth Provider Portal Account. The ForwardHealth Provider Portal Account User Guide includes information about requesting Portal access, Portal account setup, clerk Portal account setup, adding organizations, and switching organizations.
• ForwardHealth Portal Demographic Maintenance Tool User Guide – Once enrolled, providers may use the demographic maintenance tool to update their address, financial, and other information.

Other Resources

• ForwardHealth Updates – The first source of provider information. Updates announce the latest information on policy and coverage changes, claims submission requirements, and training announcements. Revisions to policy information are incorporated into the ForwardHealth Online Handbook in conjunction with published Updates. A secure ForwardHealth Portal account is not required to use the Online Handbook.
• Resources Reference Guide – Services and resources available to providers, including contact information and hours of availability.
• Portal User Guides – The ForwardHealth Portal user guides provide step-by-step instructions for navigating specific Portal functionality, such as submitting claims and prior authorization requests and accessing Remittance Advices.