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. ForwardHealth interChange Agenda . Portal information.Enrollment verification information.Review of how to do the following via the Portal:Search for claims.Void claims.Resubmit claims.Future changes to ForwardHealthRemitCORE plan implementationResourcesOnline handbookAlertsUpdatesPro
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1. ForwardHealth interChangeProvider Portal Information April 2009
2. ForwardHealth interChange Agenda Portal information.
Enrollment verification information.
Review of how to do the following via the Portal:
Search for claims.
Void claims.
Resubmit claims.
Future changes to ForwardHealth
Remit
CORE plan implementation
Resources
Online handbook
Alerts
Updates
Provider Services
Professional Relations Representative
Questions
3. ForwardHealth interChange Portal information Passwords.
Security questions.
4. ForwardHealth interChange Portal information . Password
Expire every 60 days and users are prompted to change it.
Must have at least eight characters.
Must contain at least one uppercase letter, one lowercase letter, and one number.
Must not contain your real name or user name.
When resetting your password, you cannot use any of your previous eight passwords.
If you forgot your password, you can reset it yourself by answering your security questions that you were asked to provide when you changed the initial password you received.
5. ForwardHealth interChange Portal information (cont.) Security questions
User makes up your own security questions, and must not contain any special characters i.e. *, /, ?.
Security answers are case sensitive and must not contain any special characters or spaces.
6. ForwardHealth interChange Portal information (cont.) If the user attempts to log-in 3 times with a incorrect user name or password they will be locked out. Users should only attempt log in twice and then use “Forgot password” using your security questions. They then can reset their passwords.
If a user is locked out the lock out will be for one hour. Administrators can not unlock the user accounts. EDI help desk will ask Clerk and Clerk Administrators to wait the one hour for the password reset.
7. ForwardHealth interChange Enrollment information Benefit plans-Members can have more than 1 plan active
Plan with full benefits include:
State Supplemental Payment – SSI
State Supplemental Income
Caretaker Supplement
State Supplemental Income Exceptional
BC+ Standard Plan BadgerCare
Medicaid for Foster Care
Medicaid Purchase Plan
Medicaid Purchase Plan Waiver
Medicaid
Medicaid Waiver
Medicaid for SSI
8. ForwardHealth interChange Enrollment information (cont.) Limited benefits
Tuberculosis Services Only ,TB.
Alien Emergency Services Only, AE.
Qualified Medicare Beneficiary, QMB.
Qualified Disabled Working Individuals
Specified Low-income Medicare Beneficiary Plus, SLMB.
Specified Low-income Medicare Beneficiary Plus
Presumptive Eligibility - Pregnancy
Family Care Non-MA
Family Planning Services only
9. ForwardHealth interChange Enrollment information (cont.) Limited benefits continued
Dental Ortho/Dentures Only
BC+ Standard EE for Pregnant Women
BC+ Benchmark Plan
Benchmark EE for Pregnant Women
Benchmark Plan and Dental
SeniorCare
Senior Care Level 1- 0 to 200% FPL
Senior Care Level 2- Over 200% FPL
Wisconsin Well Woman Program
Wisconsin Well Woman Medicaid
Wisconsin Chronic Disease
10. ForwardHealth interChange Enrollment information (cont.) Other enrollment information
Managed Care Enrollment.
Other Commercial Health Insurance.
Medicare.
Lock-In
Spenddown
Deductible
11. ForwardHealth interChange Portal information — Claims Search for claims.
Void claims.
Resubmit claims.
Update 2008-135Update 2008-135
28. ForwardHealth interChange Future changes Remit
To be more like old RA.
Alpha order.
Update 2008-135Update 2008-135
29. ForwardHealth interChange Core Plan Implementation Statewide.
Enrollment planned June 2009
Benefits to begin July 2009
30. ForwardHealth interChange Core Plan Enrollment
Wisconsin resident;
U.S. citizen or legal immigrant;
Age 19 through 64
Do not have children or do not have dependent children, under age 19 living with you;
Are not pregnant;
Have family income at or below 200% of the federal poverty level guidelines ($1,805 for a single person and $2,428.33 for a married couple);
31. ForwardHealth interChange Core Plan Enrollment continued
Do not have private health insurance coverage when you request Core Plan coverage or in the 12 months before that date;
Cannot sign up for insurance from an employer during month of application or next three months;
Did not have access to insurance from an employer in the 12 months before you request Core Plan coverage; and
Are not getting BadgerCare Plus, Medicaid or Medicare.
32. ForwardHealth interChange Core Plan Covered Services
Doctor visits
Hospital services
Emergency room visits
Emergency ambulance rides
Emergency dental services
Some prescription drugs
Physical therapy
Occupational therapy
Speech therapy
Cardiac rehabilitation
Durable medical equipment
Disposable medical supplies
Dialysis/Kidney-related services
Some services covered under the Core Plan will have a co-payment and service limitations. Co-payment amounts are based on income.
Enrollment information will indicate no–payment, if member does not have co-pay.
33. ForwardHealth interChange Core Plan Non-Covered services will include:
Non-emergency dental services
Chiropractic services
Hearing services
Routine vision exams
Home health care
Hospice
Inpatient mental health and substance abuse treatment services
Non-emergency transportation
Nursing home care
Podiatry
Reproductive health services (these services are covered through BadgerCare Plus Family Planning Waiver Services)
Services for children and pregnant women
34. ForwardHealth interChange Core Plan Additional information
Future updates
Statewide trainings planned for June 2009
35. ForwardHealth interChange Where to get help Portal
Alerts
Updates
On-line handbook Update 2008-135Update 2008-135
36. ForwardHealth interChange Alerts Update 2008-135Update 2008-135
37. Resources- Professional Relations Representatives
Update 2008-135Update 2008-135
38. Resources- Professional Relations Representatives
Update 2008-135Update 2008-135
39. Resources- Professional Relations Representatives
Update 2008-135Update 2008-135
40. Resources- Professional Relations Representatives hock@wisconsin.gov
Update 2008-135Update 2008-135
41. Resources- Professional Relations Representatives
Update 2008-135Update 2008-135
42. ForwardHealth interChange Questions Update 2008-135Update 2008-135
44. ForwardHealth interChange Where to get help Provider Services (800) 947-9627
Enrollment, Claims, PA and Certification issues
Information to have ready when calling
Provider name and NPI or provider ID.
Member name and member identification number.
Claim number.
PA number.
DOS.
Amount billed.
RA.
Procedure code of the service in question.
Reference to any provider publications that address the inquiry.
Update 2008-135Update 2008-135
45. ForwardHealth interChange Where to get help Professional Relations Representatives
Provider education
Provider training
Update 2008-135Update 2008-135
46. Resources- Professional Relations Representatives Jude Benish - South Central Wisconsin (608) 836-9428
E-mail judy.benish@wisconsin.gov
Joan Buntin – North Central and Dental
(715) 675 3190
E-mail joan.buntin@wisconsin.gov
Cindy Drury – Southwest Wisconsin (608) 929-4030
E-mail cindy.drury@wisconsin.gov
Denise Kruswicki – Northwest Wisconsin(715) 694-2114
E-mail denise.kruswicki@wisconsin.gov
Update 2008-135Update 2008-135
47. Resources- Professional Relations Representatives Teresa Miller – Milwaukee County(262) 695-1915
E-mail teresa.miller@wisconsin.gov
Vicky Murphy – Southeast Wisconsin
(608) 756-1422
E-mail vicky.murphy@wisconsin.gov
Maria Schwartz – Milwaukee County
(262) 695-1915
E-mail maria.schwartz@wisconsin,gov
Lori Hock – Northeast Wisconsin
(920) 465-9425
-E-mail lori.hock@wisconsin.gov
Update 2008-135Update 2008-135
48. ForwardHealth interChange Questions Update 2008-135Update 2008-135