MedicaidPrior AuthHigh impact
Prior Authorization Process Improvements: Revising the Prior Authorization Portal Submission Process
Wisconsin Medicaid (ForwardHealth)·WI·Prior Authorization
Effective date
Aug 17, 2026
We identified it
Aug 26, 2026
Summary
ForwardHealth is implementing significant prior authorization (PA) process changes effective August 17, 2026, including elimination of PA submission timeframe extensions, application of backdating policy to all PA requests, mandatory Portal-based submissions (no more fax/mail), updated PA forms for service-area providers, real-time PA end-dating capabilities, removal of PA collaboratives, and maximum quantity changes for five specific disposable medical supply codes. Billing teams must transition all PA submissions to the electronic Portal and update internal processes to comply with stricter submission requirements and incomplete PA denials.
Action Required
By August 17, 2026: Billing team must complete the following actions: (1) Ensure all providers have secure ForwardHealth Provider Portal accounts—training staff on Portal access and PA submission process is required; (2) Update billing software and internal workflows to eliminate any fax or mail-based PA submissions and enforce mandatory electronic Portal submission; (3) Update internal documentation to reflect that incomplete PA requests will now be denied (not held for 30 days)—staff must verify ALL required information and clinical documentation are attached before submission to avoid denials; (4) For service-area-specific providers (Behavioral Treatment, Chiropractic, Dental, etc.), download and implement updated PA forms (F-11030, F-11044, F-11066, F-02567, F-11051, F-03432, F-03431 dated 07/2026) in practice systems and retire old form versions; (5) For disposable medical supply claims, update quantity limits in billing system for codes A4385 (15/month), A4606 (8/month), A7008 with modifier 59 (20/month), A9277 (4/year), and T4537 (6/year); (6) For oxygen and respiratory DME requests, implement process change to submit single PA/OA form instead of separate PA/DMEA and PA/OA requests; (7) Remove PA collaborative linking functionality from submission workflows; (8) Configure Portal system to access PA decision letters electronically (no longer mailed); (9) For Behavioral Treatment, Chiropractic, and Dental service areas, implement real-time PA end-dating capability—except that Dental providers cannot end-date HCPCS D4910 in real time and must use PA amendment process instead. Failure to comply will result in PA denials for incomplete submissions, rejected claims for non-Portal submissions, and incorrect reimbursement for DMS codes with outdated quantity limits.