Prior Auth Required

11159 - Sheet (F- (10/08)) must be printed and sent with the attachment to ForwardHealth for processing. Providers must list the

This procedure appears on the selected insurer prior authorization source.

Check another codeExplore policy data
Prior authorizationPrior Auth Required
Procedure / ServiceSheet (F- (10/08)) must be printed and sent with the attachment to ForwardHealth for processing. Providers must list the
Procedure / Service Description

Wisconsin Medicaid - Providers may also choose to submit their PA request on the Portal and mail or fax the PA attachment(s) and/or additional supporting documentation to ForwardHealth. If the PA attachment(s) are mailed or faxed, a system-generated Portal PA Cover Sheet (F-11159 (10/08)) must be printed and sent with the attachment to ForwardHealth for processing. Providers must list the attachments on the Portal PA Cover Sheet. When ForwardHealth receives the PA attachments by mail or fax, they will be matched up with the PA/RF (Prior Authorization Request Form, F-11018 (05/13)) that was completed on the Portal.

Likely documents
  • Confirm benefit details
  • Submit clinical notes if requested by the plan
Next actions
  • Confirm the current plan policy before submission.
  • Use the insurer authorization workflow for this listed code.