Children's Long-Term Support (CLTS): Third Party Administration (TPA)Transition for Providers
The CLTS Program Participant and Family Handbook is here!
This easy-to-use handbook was created to help families better understand the CLTS Program, so they can better access available supports and services and navigate the program with confidence.
Get the Children’s Long-Term Support Program Participant and Family Handbook, P-03689.
The claims processor for the CLTS Program will transition from TPA Wisconsin Physicians Service (WPS) to fiscal agent Gainwell Technologies, LLC. (GWT). The anticipated date of this transition is May 5, 2025. This is a temporary webpage that provides information on processes with GWT after the transition. Find information on current processes with WPS.
If you have any questions on the transition to Gainwell Technologies, contact the CLTS Operations Team at
Claim submission
- Medicaid IDs (MA IDs) or National Provider Identifiers (NPIs) are required to process CLTS claims.
- Tax IDs will no longer be accepted.
- Non-healthcare providers who do not have an NPI will submit claims using their MA ID with all claim submission methods.
- Healthcare providers who do have an NPI:
- Must submit the NPI on claims submitted via the electronic 837 method. Cannot submit MA ID on an 837.
- Will use the MA ID to submit on all other claim submission methods. Can also include NPI.
- New and existing providers will be assigned an MA ID for the CLTS Program.
- Providers will receive a letter that will contain their PIN to log in to the ForwardHealth Portal. This letter will also contain their MA ID.
- Each service location or directory location will have a unique MA ID.
- Providers are encouraged to ensure their registration is up to date now.
- The DHS CLTS Registry remains the “source of truth” for provider information, meaning all changes must be made in this registry. DHS passes this information to Gainwell to upload to their provider file and ForwardHealth Portal.
- If you have one location:
- Enter this as your main Business Name and Business Address.
- Enter this as your Directory Location.
- If you have more than one location:
- Enter your main location as your Business Name and Business Address.
- Enter your main location as a Directory Location.
- Enter all other service locations as a Directory Location.
To update your information, visit the CLTS Provider
ForwardHealth Portal
- Direct Data Entry (DDE)
- Claim Wizard allows providers to directly enter a claim into the ForwardHealth Portal.
- Copy a Claim
- The ForwardHealth Portal saves claim information and allows providers to copy a claim, in a paid status, to a new claim for easy editing before submitting it as a new claim.
- Create a Claim from a prior authorization (PA)
- Allows users to create a claim based on information from the PA, with information prepopulated on the claim.
- Electronic Data Interchange (EDI): 837 Health Care Claim transactions
- 837 transactions will continue to be accepted.
- Companion guides give ForwardHealth-specific information for exchanging electronic transactions and can be accessed on the Portal.
Paper
- 1500 Health Insurance Claim Form and UB-04 Claim Form
- Providers can mail in paper claim forms.
Claim adjustments
Adjustments via paper or 837
Claims originally processed by WPS or by Gainwell:
- Can be submitted via a paper adjustment request form.
- Fill out the ForwardHealth Adjustment/Reconsideration Request form, F-13056 (PDF), using the ForwardHealth Adjustment/Reconsideration Request Completion Instructions, F-13056 (PDF).
- Mail the completed form to:
CLTS Program
Claims and Adjustments
313 Blettner Blvd.
Madison, WI 53784
- Can be submitted via an 837.
- When adjusting a claim with an 837, enter “7” as the frequency code to replace the claim.
- When adjusting a claim with a UB-04, enter “7” in the “Type of Bill” field and specify the reason for the adjustment in the remarks section.
Adjustments via direct data entry
- Claims originally processed by WPS cannot be submitted via direct data entry into the ForwardHealth Portal.
- Claims originally submitted by Gainwell can be submitted via Direct Data Entry into the ForwardHealth Portal.
CLTS fee schedules
- The maximum (max) fee schedules can be accessed from the Portal home page and the provider home page.
- CLTS max fee schedules will be available Spring 2025.
Date-span billing and foster care claims
- Bill dates of service when services were provided within the authorized date span.
- When to use a date span versus one day of service:
- Services were performed on consecutive dates: Bill a date span (for example, Aug. 1–7).
- Services were performed on two or more different dates: Bill one date per claim line (for example, Aug. 1, Aug. 3, and Aug. 7).
Diagnosis (ICD-10) Codes
New requirement to submit International Classification of Diseases (ICD)-10th Revision Clinical Modification (CM) codes on claims.
- Will be included on the PA.
- Will be a specific diagnosis code or Z41.8 – encounter for other procedures for purposes other than remedying health state, unspecified.
Place of Service (POS)
- New requirement to submit POS code on claims.
- Will not be included on PA to continue to allow flexibility for POS 02 Remote Services.
- Guidance will be found in the ForwardHealth Portal in the CLTS Max Fee Schedule for all procedure codes.
- Guidance will also be found in the Claims Submission User Guide.
- Will be included in claims submission training closer to the transition date.
Resources
Provider Readiness Checklist
Used to prepare for the TPA transition. View the checklist
(PDF) (opens external link) .Frequently Asked Questions (FAQs)
Explains what will change, what trainings will be available, and when the transition will happen. View the FAQs
(PDF) (opens external link) .ForwardHealth Professional Claims User Guide, P-00970a
Explains how to submit professional claims in the Portal. View the professional claims user guide, P-00970a (PDF).
ForwardHealth Institutional Claims User Guide, P-00970
Provides general instructions for completing an institutional claim through the Portal. View the institutional claims user guide, P-00970 (PDF).
Children’s Long-Term Support Program Place of Service Codes
Table of place of service codes for CLTS services. View the place of service codes
(PDF) (opens external link) .
User
Provider TPA events
New provider and refresher training
Group One (Self-Identified: Technology Savvy)
- April 24, 2025 5–6:30 p.m.
Provider webinars
April 16, 2025
- Agenda: Project timeline, implementation dates, finding your Medicaid ID, multiple dates of service, code crosswalk, place of service codes, payment and remittance advice schedules, outstanding checks and recovery
- Apr. 16, 2025 recording (opens external video)
- Apr. 16, 2025, presentation (PDF)
March 19, 2025
- Agenda: Project timeline, implementation dates, Submission Sandbox testing, Hypercare plan, PA batches, provider TPA transition, webpage: what’s new?, CLTS Operations Center support, training opportunities
- Mar. 19, 2025, recording (opens external video)
- Mar. 19, 2025, presentation (PDF)
December 17, 2024
- Agenda: Project timeline, implementation dates, payment and electronic funds transfer, date span clarifications and examples, International Classification of Diseases Tenth Edition (ICD-10) codes on Wisconsin Physicians Service (WPS) transfer prior authorizations, prior authorization number on claims, ForwardHealth Portal access, provider testing process and submission sandbox, training information
- Dec. 17, 2024 recording (opens external video)
October 31, 2024
- Agenda: Project timeline, provider survey, implementation dates, new payment and remittance advice schedules, Medicaid IDs, date span billing, direct data entry rejections, training information, what’s next
- Oct. 31, 2024, recording (opens external video)
- Oct. 31, 2024, presentation (PDF)
August 21 and August 28, 2024
- Agenda: Project timeline, third-party administrator (TPA) transition webpage, implementation dates, new overpayment recovery process, summary of design changes, what’s next
- August 21, 2024, recording (opens external video)
- August 28, 2024, recording (opens external video)
- Aug. 21 and 28, 2024, presentation (PDF)
Demonstration sessions
November 13, 2024: Overview of Portal Navigation and Claims Submission Options
- Agenda: Navigating the ForwardHealth Portal, portal resources, claim submission options, direct data entry, paper claim, 837 submission
- November 13, 2024, recording (opens external video)
- November 13, 2024 presentation (PDF)
August 13 and 15, 2024, How to Submit an 837 Demonstration
- Agenda: 837 claims, converting Excel files to 837 claims, uploading 837 files to the ForwardHealth Portal, finding help
- August 13, 2024, recording (opens external video)
- August 15, 2024, recording (opens external video)
July 24 and 25, 2024, Portal and Claims Submission Demonstration Sessions
- Agenda: Navigating the ForwardHealth portal, claim submissions options, where to find resources
- July 24, 2024, recording (opens external video)
- July 25, 2024, recording (opens external video)
- July 24 and 25, 2024, presentation (PDF)
Provider forums
May 16, 2024, CLTS TPA Transition Provider Forum
- Agenda: Updated project timeline, ForwardHealth portal, claims submission general updates, claims submission options, Medicaid IDs
- May 16, 2024, recording (opens external video)
- May 16, 2024, presentation (PDF)
January 11, 2024, CLTS Program TPA Transition Financial Management Services Provider Forum
- Agenda: CLTS TPA transition overview, forum objectives, claims submission functionality, viewing claims, viewing prior authorizations
- Jan. 11, 2024, recording (opens external video)
- Jan. 11, 2024, presentation (PDF)
January 9, 2024, CLTS Program TPA Transition Financial Management Services Provider Forum
- Agenda: CLTS TPA transition overview, forum objectives, claims submission functionality, viewing claims, viewing prior authorizations
- Jan. 9, 2024, recording (opens external video)
- Jan. 9, 2024, presentation (PDF)
January 4, 2024, CLTS Program TPA Transition Financial Management Services Provider Forum
- Agenda: CLTS TPA transition overview, forum objectives, claims submission functionality, viewing claims, viewing prior authorizations
- Jan. 4, 2024, recording (opens external video)
- Jan. 4, 2024, presentation (PDF)
November 30, 2023, CLTS Program TPA Transition
- Agenda: CLTS TPA transition overview, claims submission functionality, viewing claims history and prior authorizations
- Nov. 30, 2023, recording (opens external video)
- Nov. 30, 2024, presentation (PDF)