Information for Dates of Service On and After October 1, 2015

Providers submitting claims for members enrolled in Family Planning Only Services are required to indicate one of the following on the detail level of the claim:

• An appropriate allowable ICD diagnosis code from the list of allowable contraceptive management codes as a primary or secondary diagnosis if the service provided was related to contraceptive management, as applicable.
• Modifier FP associated with the procedure code if the service provided was related to family planning when an allowable contraceptive management diagnosis code is not appropriate, for example, when billing a colposcopy provided in follow up to a contraceptive management visit.

Claims for members enrolled in Family Planning Only Services that are submitted without either an allowable primary ICD contraceptive management diagnosis code or modifier "FP" associated with an allowable procedure code will be denied.

Providers who submit claims using NDCs are required to indicate the NDC from the package of the drug that is dispensed.

If a provider performs services for a member who is temporarily enrolled in Family Planning Only Services through EE, the member's enrollment information may not yet be available through Wisconsin's EVS or the ForwardHealth Portal. To avoid delays in reimbursement, providers who provide Family Planning Only Services to a member who is temporary enrolled through EE before the member's enrollment in ongoing Family Planning Only Services coverage can be verified should do the following:

• Make a photocopy of the Temporary Identification Card for Express Enrollment in Family Planning Only Services to be used, if necessary, for good faith claims processing.
• Wait until enrollment for ongoing Family Planning Only Services coverage has been verified through the EVS or Portal and then submit the claim.