Prior Authorization Process Improvements: Revising the Prior Authorization/Chiropractic Attachment and Adding a Chiropractic Procedure Code

REQUIREMENTS: By April 2026 (form revision effective date): Billing team must update all prior authorization submission processes to use the revised PA/Chiropractic Attachment form (F-11029, 04/2026) available on the ForwardHealth Portal. Stop submitting the old form immediately — claims using the old form will be rejected. Ensure all providers have Portal access by reviewing the ForwardHealth Provider Portal Account User Guide. Effective January 1, 2026: Billing team and providers must begin billing CPT code 98943 (Chiropractic manipulative treatment; extraspinal, 1 or more regions) for eligible chiropractic services. Code 98943 can be used once per date of service in conjunction with codes 98940, 98941, or 98942 (spinal CMT codes) but only once per DOS. Update billing software to recognize 98943 and apply the same prior authorization rules as the existing spinal CMT codes (98940, 98941, 98942). Immediately: Update encounter forms, templates, and provider communication materials to reflect the new code availability and revised PA form requirements. Verify all documentation retention practices comply with Wis. Admin. Code § DHS 106.02(9) — failure to produce requested documentation may result in claim denial, recoupment, or program termination. For managed care organizations: Contact the appropriate MCO for implementation guidance, as this policy applies to fee-for-service Medicaid only.