Verbal Orders for Plans of Care Allowed on Home Health Prior Authorization Requests

By August 17, 2026: Billing and prior authorization teams must implement the following workflow changes: (1) Update PA submission procedures to accept written plans of care signed by authorized providers (nurses or therapists) WITH documented verbal orders from prescribing providers as valid initial submissions; (2) Establish a 20-business-day tracking system to monitor verbal order submissions and flag when amendment requests (with prescriber-signed plans of care) must be submitted to ForwardHealth; (3) Train home health agency staff to document and retain proof that written orders were sent to prescribers BEFORE the requested service start date; (4) Configure billing system to issue temporary 20-day authorizations for verbal order submissions and override to full duration once signed amendment is received and approved; (5) Ensure all PA amendments with prescriber-signed plans of care are submitted through the ForwardHealth Portal before the original PA expires; (6) Maintain complete documentation of verbal orders, written orders, dates sent to prescriber, and prescriber signatures per Wisconsin Administrative Code § DHS 106.02(9), as DHS may audit records and deny/recoup payments for non-compliant claims. Failure to submit timely amendments or maintain required documentation will result in claims being denied or recouped, and continued non-compliance may trigger intermediate sanctions or program termination.