wisconsin.gov HomeState AgenciesDepartment of Health Services
Welcome  » April 25, 2024 11:53 AM
Login
Search
Alerts
  • Change Healthcare (CHC) has begun submitting some batch X12 electronic transactions to ForwardHealth. The volume of backlogged claims held by CHC and the amount of time it will take CHC to send them is unknown. Once claims are acquired from CHC, ForwardHealth will process them in the order received.

    Visit the Change Healthcare Service Interruption: Resources page for more information on the security incident and for ForwardHealth resources.

  • Multi-factor authentication (MFA) is now required for the secure ForwardHealth Portal. Providers are encouraged to refer to the ForwardHealth Multi-Factor Authorization Instruction Sheet for help setting up MFA preferences.
    Providers may contact their Portal account administrator or call the ForwardHealth Portal Help Desk at 866-908-1363. Note: This is a project-specific announcement and is not related to the Change Healthcare disruption.
Enhanced Ambulatory Patient Groups Home Page

Enhanced Ambulatory Patient Groups (EAPG)

ForwardHealth uses the Enhanced Ambulatory Patient Group (EAPG) classification system to calculate pricing for outpatient hospital claims. The groups used in the EAPG system categorize the amount and type of resources used in various outpatient visits. Under the EAPG classification system, reimbursement for outpatient hospital services is based on the quantity and type of services provided. The system ensures that both low- and high-cost services are reimbursed appropriately.

The EAPG reimbursement methodology applies to fee-for-service members enrolled in BadgerCare Plus, Wisconsin Medicaid, and the Wisconsin Chronic Disease Program.

EAPG was implemented for fee-for-service claims on April 1, 2013, and extended to HMO encounters on January 1, 2015. ForwardHealth continues to publish rate-per-visit information for county jail reference. Current version information and installation dates for the EAPG Grouper, the 3M Grouper Plus Content Services (GPCS) platform, and the APR DRG Grouper can be found on the Hospital Rates and Weights Portal page.

ForwardHealth Updates

2013-07 Enhanced Ambulatory Patient Groups Implementation and Additional Training Dates, 2/1/13
2012-55 Implementation of the Enhanced Ambulatory Patient Groups Reimbursement Methodology, 10/5/12
2012-53 Revenue Codes Exempt from the Procedure Code Requirement for Outpatient Hospital Services, 10/2/12
2012-26 Appropriate Modifiers and Most Specific Diagnosis Codes Required on Outpatient Hospital Claims, 6/25/12
2012-24 Procedure Codes Required with All Revenue Codes on Outpatient Hospital Claims, 6/6/12

Provider Trainings

The following presentations were developed for HMO EAPG implementation. However, most of the content is applicable to both fee-for-service claims and HMO encounters.

EAPG Rates and Weights

Current and archived EAPG rates and weights are available.

Additional Information

  • EAPG Definitions Manual Request Form
  • Providers with questions regarding fee-for-service EAPG claims may e-mail them to vedseapgsupport@wisconsin.gov
    • Questions should not be sent in a secured format (e.g., Zix Email Encryption), because these messages cannot be opened for security reasons.
  • HMOs with questions regarding EAPG encounters may e-mail them to vedshmosupport@wisconsin.gov
    • Questions should not be sent in a secured format (e.g., Zix Email Encryption) because these messages cannot be opened for security reasons.
  • Provider Services: (800) 947-9627
Frequently Asked Questions
 
 
About  |  Contact |  Disclaimer  |  Privacy Notice
Wisconsin Department of Health Services
Production PROD_WIPortal2_M948__7
Browser Tab ID: 1   -1