CLTS Prior Authorization Updates for TPA Transition

Wisconsin Department of Health Services sent this bulletin at 04/28/2025 09:56 PM CDT
Wisconsin Department of Health Services

Children's Long-Term Support Updates for Counties

CLTS Prior Authorization Updates for TPA Transition

The Wisconsin Department of Health Services (DHS) has transitioned from Wisconsin Physicians Service (WPS) to Gainwell Technologies, as the state’s processor for the Children's Long-Term Support (CLTS) Program prior authorizations (PAs) and claims using the ForwardHealth Portal (Portal). DHS is sharing important updates on PAs.

Payment Method

County waiver agencies (CWAs) testing PAs in the submission sandbox have raised concerns about how payment methods work. Some CWAs got unexpected results when submitting PAs. Gainwell Technologies has now updated the system to ensure that CWAs receive the expected results for their submission. The payment method will automate depending on the number of units a CWA enters on their PA. See the April 17 CLTS Prior Authorization Payment Method Updates message for more details about payment method updates.

WPS PA Conversion

PAs that were on file with WPS on and before April 18, 2025, are available in the portal for CWAs starting Monday, April 28, 2025.

CWAs will notice two changes to their PAs, if applicable.

  1. Authorizations on file with WPS with an “amount” frequency type of 1 unit, will be changed to 0 units in the portal. This aligns with the Pay Dollar Limit payment method.
  2. CWAs using subcontracted agencies for support and service coordination will now have a U5 modifier on case management (T1016) PAs for those agencies.

Bulk PA Report

CWAs will use the “PA Search-Bulk” feature in the Prior Authorization tab, to find the new  Gainwell PA numbers for all converted PAs. The report will also provide CWAs with the assigned WPS authorization number.

To run the report, CWAs will enter the date span and any other filtering information if needed, then hit “export.”

Note: Hitting “search” may result in an error due to the volume of the report. Using the “export” button immediately will prevent the error.

The report will provide important details, including:

  • New Gainwell number
  • Diagnosis codes
  • CWA PA number, if applicable
  • Service code
  • Billing provider ID/Medicaid ID
  • Modifiers
  • Member ID
  • Units authorized, remaining, and used
  • Participant name
  • Dollars authorized, remaining, and used
  • PA start and end dates
  • Internal text: WPS authorization number

Have questions or need help?

If you have questions or need help, please contact the CLTS Operations Team at cltsoperations@gainwelltechnologies.com or 844-942-5870.