MedicaidPrior AuthHigh impact
ForwardHealth Update 2025-35: Prior Authorization Process Improvements: Overview
Wisconsin ForwardHealth·WI · Psychiatry, Chiropractic, Dentistry +3 more·Prior Authorization
Effective date
Jan 1, 2026
We identified it
Jun 18, 2026
Summary
ForwardHealth is implementing prior authorization process improvements for Wisconsin Medicaid and BadgerCare Plus in two phases: January 1, 2026 brings new urgent PA identification requirements, clearer denial messages, new PA status categories, and a revised fax cover sheet; January 1, 2027 establishes mandatory processing timeframes of 72 hours for urgent and 7 days for non-urgent requests.
Action Required
By January 1, 2026: Billing team must update PA submission workflows to check the 'Urgent' checkbox on ForwardHealth Portal for urgent requests and attest in description box that delay would risk member's life/health or cause severe pain. Replace all Prior Authorization Fax Cover Sheets with new version F-01176 (12/2025) - old forms will be rejected after this date. Train staff on new 'inactive - PA void' status for tracking inappropriate PA submissions. By January 1, 2027: Prepare for stricter processing timelines of 72 hours for urgent and 7 days for non-urgent PA requests.