Wis. ForwardHealth Online Handbook, Hospice, Topic #4741

Providers can accomplish many processes via the ForwardHealth Portal, including submitting, adjusting, and correcting claims,

submitting and amending PA (prior authorization) requests, and verifying enrollment.

Claims and Adjustments Using the Portal

Providers can track the status of their submitted claims, submit individual claims, correct errors on claims, and determine what

claims are in pay status on the Portal. Providers can search for and view the status of all of their finalized claims, regardless of how

they were submitted (for example, paper, electronic, clearinghouse). If a claim contains an error, providers can correct it on the

Portal and resubmit it to ForwardHealth.

Providers can submit an individual claim or adjust a claim via DDE (Direct Data Entry) through the secure Portal.

Submitting PA and Amendment Requests via the Portal

Nearly all service areas can submit PA requests via the Portal. Providers can do the following:

• Correct errors on PA or amendment requests via the Portal, regardless of how the PA request was originally submitted.

• View all recently submitted and finalized PA and amendment requests.

• Save a partially completed PA request and finish completing it at a later time. (Note: providers are required to submit or re-

save a PA request within 30 calendar days of the date the PA request was last saved.)

• View all saved PA requests and select any to continue completing or delete.

• View the latest provider review and decision letters.

• Receive messages about PA and amendment requests that have been adjudicated or returned for provider review.

Electronic Communications

The secure Portal contains a two-way message center where providers can send and receive electronic notifications as well as

receive links to ForwardHealth provider publications. Providers will be able to send secure messages to select Wisconsin DHS

(Department of Health Services) groups/staff by selecting a recipient from a drop-down menu; options in the drop-down menu

will differ based on the provider's security role. All new messages will be displayed on the provider's secure Portal messages

inbox.

Providers can sign up to receive notifications about the availability of new ForwardHealth messages through email, text, or both.

After signing up, the user will receive a verification email to register their device. Once registered, providers will receive

notifications by the requested method(s).

Enrollment Verification

The secure Portal offers real-time member enrollment verification for all ForwardHealth programs. Providers are able to use this

tool to determine:

• The health care program(s) in which the member is enrolled.

• Whether or not the member is enrolled in a state-contracted MCO (managed care organization).

• Whether or not the member has other health insurance (for example, commercial health insurance, Medicare, Medicare

Advantage Plans), such as Medicare or commercial health insurance.

Using the Portal to check enrollment may be more efficient than calling the AVR (Automated Voice Response) system or the EVS

(Enrollment Verification System) (although both are available).

Providers will be assigned a unique enrollment verification number for each inquiry. Providers can also use the print screen

function to print a paper copy of enrollment verification inquiries for their records.

Other Business Enhancements Available on the Portal

The secure Provider area of the Portal enables providers to do the following:

• Verify member enrollment.

• View RAs (Remittance Advices).

• Designate which trading partner is eligible to receive the provider's 835 (835 Health Care Claim Payment/Advice)

transaction.

• Update and maintain provider file information; providers will have the choice to indicate separate addresses for different

business functions.

• Receive electronic notifications and provider publications from ForwardHealth.

• Enroll in EFT (electronic funds transfer).

• Track provider-submitted PA requests.