MedicaidPrior AuthHigh impact
ForwardHealth Portal Prior Authorization Electronic Upload Enhancements for Personal Care Services
Wisconsin Medicaid (ForwardHealth)·WI · Occupational Therapy, Physical Therapy·Prior Authorization
Effective date
Jun 14, 2025
We identified it
Aug 26, 2026
Summary
Effective June 14, 2025, ForwardHealth has enhanced the prior authorization portal for personal care services to enable real-time review eligibility. Providers must now submit ALL required clinical documentation through the Electronic Upload option during PA submission to qualify for real-time review and potential approval within seconds; mailed, faxed, or partial electronic submissions will be manually reviewed. The Portal PA process has been restructured with new steps, integrated form fields, and questions about EVV exemptions and medically oriented tasks.
Action Required
By June 14, 2025: (1) Billing and PA submission staff must transition ALL personal care service PA requests to the ForwardHealth Portal using the Electronic Upload option—do NOT use mail or fax submissions if real-time review is desired. (2) Update internal workflows to require providers to gather ALL required clinical documentation BEFORE initiating PA submission (providers will be prompted for a specific list based on their responses during PA submission). (3) Train staff on the new Portal PA process sequence: member information → service details (units, PRN time, EVV exemption, travel time) → document upload → attestation → diagnosis/provider info → submission. (4) Ensure providers understand that EVV exemptions and MOTs beyond medication assistance are NOT eligible for real-time review and will be manually processed. (5) Update billing system and encounter forms to prompt for complete documentation upfront. Consequences: PAs submitted via mail/fax will experience longer processing delays; incomplete electronic submissions will default to manual review; claims may be denied if documentation retention requirements per Wis. Admin. Code § DHS 106.02(9) are not met. Note: MCOs must provide at least the same benefits—contact your managed care organizations for implementation details.