Claim Suspensions in the ForwardHealth Portal
The Wisconsin Department of Health Services (DHS) Children's Long-Term Support (CLTS) Program is providing guidance to reduce claim suspensions in the ForwardHealth Portal.
What are suspended claims?
Suspended claims are claims awaiting further review. Suspended claims are manually reviewed by the ForwardHealth claims team and are paid or denied based on the review of submission details.
The following are the top claims suspension reasons for CLTS providers:
- 603 – Attachment indicated but not yet received
- 3000 – Units Exceed Authorized Units on Prior Authorization (only partial units available)
- 3009 – Partial Prior Authorization (PA) Found (some claim dates are within the PA effective date range and some claim dates are not included in the PA effective date range)
How to prevent claim suspensions
This guidance will help decrease claims suspensions overall, including suspensions for the three most common reasons:
- Only select “add attachment” when necessary for the claim submission. If an attachment is necessary, provide the attachment as soon as possible to expedite claim processing.
- Review PA details; confirm the correct dates of service and units available.
- Refrain from resubmitting claims while in “suspend status.”
For more details related to this topic access the ForwardHealth Portal Professional Claims User Guide.
Have questions or need help with claims?
If you have questions or need help, please contact the CLTS Operations Team at cltsoperations@gainwelltechnologies.com or 844-942-5870.
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