Wis. ForwardHealth Online Handbook, Hospice, Topic #10837

In some instances, ForwardHealth requires providers to include a description of a service identified by an unlisted, or NOC (not

otherwise classified), procedure code. Providers submitting claims electronically should include a description of an NOC

procedure code in a Notes field, if required. The Notes field allows providers to enter up to 80 characters. In some cases, the

Notes field allows providers to submit NOC procedure code information on a claim electronically instead of on a paper claim or

with a paper attachment to an electronic claim.

The Notes field should only be used for NOC procedure codes that do not require PA (prior authorization).

Claims Submitted via the ForwardHealth Portal Direct Data Entry or

Provider Electronic Solutions

A notes field is available on the ForwardHealth Portal DDE (Direct Data Entry) and PES (Provider Electronic Solutions) software

when providers submit the following types of claims:

• Professional

• Institutional

• Dental

On the professional form, the Notes field is available on each detail. On the institutional and dental forms, the Notes field is only

available on the header.

Claims Submitted via 837 Health Care Claim Transactions

ForwardHealth accepts and utilizes information submitted by providers about NOC procedure codes in certain loops/segments on

the 837 (837 Health Care Claim) transactions. Refer to the companion guides for more information.