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Wisconsin Medicaid (ForwardHealth)Medicaid · Prior Auth · Prior Authorization · WI · Psychiatry, PediatricsMedium impact

Prior Authorization Process Improvements: Behavioral Health Form Updates

Act
by Nov 16, 2026
Effective date
Nov 16, 2026
Identified
Nov 7, 2026

Summary

ForwardHealth (Wisconsin Medicaid) published an update effective November 16, 2026 requiring behavioral health providers to use revised prior authorization forms (F-11038, F-11040, F-11036, all dated 11/2026) for adult mental health day treatment, child/adolescent day treatment, and intensive in-home mental health and substance abuse treatment for children. Several previously required clinical attachments are no longer required for PA submissions starting that date.

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What to do

by Nov 16, 2026 · 7 steps
01Billing team and clinical staff for adult mental health day treatment, child/adolescent day treatment, and intensive in-home treatment services should switch to the revised PA attachments (PA/AMHDTA F-11038, PA/CADTA F-11040, PA/ITA F-11036) in the ForwardHealth Provider Portal, since PA forms are generated automatically there.
02Before submitting, assemble the required clinical documentation for each service type: biopsychosocial assessment, functional assessment with level-of-care determination, treatment plan and continuing care plan for adult day treatment; prescription, assessment, multidisciplinary treatment plan and continuing care plan for child/adolescent day treatment; and prescription, CANS/Achenbach/CAFAS summaries, assessments, multi-agency treatment plan, in-home recovery treatment plan and continuing care plan for intensive in-home treatment.
03Update the PA tracker and checklists so staff stop using archived forms (F-11103, F-00212, F-11031, F-11032, F-11033, F-11088) for PA submissions from that date.
04Tell providers and front desk staff about the form change.
05Claims submitted with PA requests lacking the required documentation may be denied, and records must be retained under Wis.
06Admin.
07Code § DHS 106.02(9).

Original notice

Prior Authorization Process Improvements: Behavioral Health Form Updates
forwardhealth.wi.gov · Always check the source before changing claims.
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Related policy hubs

Wisconsin Medicaid (ForwardHealth) policiesWI policy changesPsychiatryPediatrics

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