Wis. ForwardHealth Online Handbook, Hospice, Topic #473

Professional field representatives, also known as field representatives, are available to assist providers with complex billing and

claims processing questions. Field representatives are located throughout the state to offer detailed assistance to all

ForwardHealth providers and all ForwardHealth programs.

The field representatives are assigned to specific regions of the state. Most professional field representatives can address inquiries

for all provider types. However, certain dedicated professional field representatives are assigned to the following:

• Adult long-term care

• Dental providers

• Milwaukee County

• PNCC (Prenatal care coordination) and CCC (child care coordination)

• WWWP (Wisconsin Well Woman Program)

Provider Education

The field representatives' primary focus is provider education. They provide information on ForwardHealth programs and topics in

the following ways:

• Conducting provider training sessions throughout the state

• Providing training and information for newly enrolled providers and/or new staff

• Participating in professional association meetings

Providers may also contact the field representatives if there is a specific topic, or topics, on which they would like to have an

individualized training session. This could include topics such as use of the ForwardHealth Portal (information about claims,

enrollment verification, and PA (prior authorization) requests on the Portal). Refer to the Providers Trainings page for the latest

information on training opportunities.

Additional Inquiries

Providers are encouraged to initially obtain information through the Portal, WiCall, and Provider Services. If these attempts are

not successful, field representatives may be contacted for the following types of inquiries:

• Claims, including discrepancies regarding enrollment verification and claim processing

• PES (Provider Electronic Solutions) claims submission software

• Claims processing problems that have not been resolved through other channels (for example, phone or written

correspondence)

• Referrals by a Provider Services phone correspondent

• Complex issues that require extensive explanation

At times, professional field representatives work outside their offices to provide on-site service; therefore, providers should be

prepared to leave a complete message when contacting field representatives, including all pertinent information related to the

inquiry. Member inquiries should not be directed to field representatives. Providers should refer members to Member Services.

If contacting a field representative by email, providers should ensure that no individually identifiable health information, known as

PHI (protected health information), is included in the message. Discuss the appropriate method of sending emails with your

assigned field representative to ensure secure transmission of information.

Providers or their representatives should have the following information ready when they contact their professional field

representative:

• Name or alternate contact

• County and city where services are provided

• Name of facility or provider whom they are representing

• NPI (National Provider Identifier) or provider number

• Phone number, including area code

• A concise statement outlining concern

• Days and times when available

For questions about a specific claim, providers should also include the following information:

• Claim number

• DOS (date of service)