CLTS Prior Authorization Payment Method Updates
Important update on the functionality and usability of the prior authorization (PA) payment method in the submission sandbox
The Wisconsin Department of Health Services (DHS) is preparing to transition from Wisconsin Physicians Service (WPS) to Gainwell Technologies, the state’s fiscal agent, for Children's Long-Term Support (CLTS) Program claims processing using the ForwardHealth Portal.
What is a PA payment method?
Payment methods are the same as WPS "frequency types." The portal has two payment method types, determined by units approved:
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0 units = Pay dollar limit
The dollar amount is approved with zero units. The portal will pay claims until approved dollars have been decremented.
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1 unit or more = Pay unit fee price with unit limit
Units are approved with a certain dollar amount for each unit. The portal will pay claims until approved units have been decremented.
Submission sandbox concerns
County Waiver Agencies (CWAs) have been testing prior authorizations in the submission sandbox and sharing concerns on the functionality and usability of payment methods. CWAs are not receiving expected results when submitting PAs.
Next steps
Gainwell Technologies is working to update the current functionality so that CWAs receive the expected results when submitting a PA. Once Gainwell Technologies has completed their updates, the payment method will automate depending on the number of units a CWA enters on their PA. This update will minimize errors CWAs are currently receiving in the submission sandbox and will result in a smoother transition for new PAs at go-live. DHS will notify all CWAs when this update is complete.
Federal procedure codes not on the CLTS Rate Schedule have resulted in the majority of submission sandbox errors. CWAs are encouraged to continue testing in the submission sandbox during this update using federal procedure codes identified on the CLTS Rate Schedule.
Questions?
For more information on the transition, please visit the DHS CWA TPA Transition page.
If you have questions, or would like a one-on-one session on the ForwardHealth Portal, please contact the CLTS Operations Team at cltsoperations@gainwelltechnologies.com or 844-942-5870.
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