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Dane County Department of Human Services Provider Hub

Children's Long Term Support (CLTS)

Authorization Process

  1. Dane County sends revised CLTS authorizations to contracted providers typically twice a week via email and attached Excel spreadsheet. Additionally, CLTS providers can create an account to view authorizations through WPS' Provider Portal. Visit the WPS CLTS page for more information and/or to create an account for their Portal. Please be sure to review the authorization file to make sure it lists the children and the services for which your agency expects to be paid.
  2. Authorized services come from the CLTS child's Individual Service Plan (ISP). The ISP is developed in conjunction with the child, their family/guardian, and their Support and Service Coordinator. If the authorized services do not appear to be what was discussed, please contact the Support and Service Coordinator to review dates of service, number of sessions, cost, etc.
  3. Ongoing CLTS services that are not one-time or time limited, will have end-dates that reflect the end of the year or the child's recertification month (whichever is soonest). Services will automatically resume or be authorized on the first of the year or the first of the month following the child's recertification.
  4. Authorized services will remain visible on the authorization file (Excel spreadsheet) for up to 150 days. After 150 days, the service will drop off the file to reduce the size of the authorization spreadsheet. This does not mean the service has been cancelled; it only means that after 150 days it no longer shows up on the authorization file you receive from Dane County.

Submitting Claims to WPS

  • All the information needed to submit a claim to WPS is on the authorization file, e.g., child name, DOB, dates of service, HCPCS code, modifier (if specified), units allowed, and Participant ID number. Please note Dane County uses the term MCI # on the authorization file, which is the same thing as Participant ID # on the WPS claim form.
  • Claims are submitted to WPS either electronically or US Postal Service. More information on claim submission is found on this WPS CLTS webpage.
  • CLTS providers are paid via direct deposit or paper check for claims. More information to receive payments electronically instead of paper check is found on this WPS CLTS webpage.
  • Do not submit a claim for any service that is not on the authorization file. These claims will be rejected. WPS will not accept any claims that have not been authorized.
  • Claims must be received by WPS within 365 days of the date of service. If claim submitted after 365 days, WPS will deny claim as TFO. Information about TFO denials can be found here.
  • The CLTS program is a Medicaid-funded program and therefore is the payer of last resort. If your program needs to first bill primary insurance (e.g., parent's insurance) for a children's service, the 365-day clock starts from the primary payer's processed date.

Resolving Errors and Denied Claims

  1. After a provider submits a claim to WPS, the status of what has been paid or not been paid will be disclosed on the Provider Remittance Advice (PRA). The PRA is typically mailed. Any claims partially paid or denied will include a denial code or reason why the claim was not fully paid. A list of codes with their explanations is found on the WPS CLTS webpage.
  2. WPS encourages providers to start with the call center 877-298-1258 or FCWPS@wpsic.com (email WPS CLTS) to begin the process of resolving claim denials. Please have the claim number handy to relay to the WPS representative.
  3. Some denied claims will require intervention by either the child's Support and Service Coordinator and/or county administrative staff. Here are some tips on how to start resolving denied claims from common error messages:

    • Code FAE: The authorized number of units or amount for this service has been exceeded. Contact the Support and Service Coordinator because the number of units and/or dollar amount for this authorized service has been exhausted and will need to be increased. Please note authorizations will not automatically be increased. Providers and the Support and Service Coordinator should be having ongoing conversations about the number of units and/or costs of the service.

    • Code FAB: There is no authorization on file for this participant for the dates of service, procedure code, modifier, or provider billed on the claim. Review your authorization file to see if the claim submitted matches the information on the authorization file.

    • Code CDD: The claim is a duplicate of a previously submitted claim. This denial is given when a provider submits more than one claim for the same child, on the same day, with the same procedure code. Typically, respite providers encounter this denial when they submit a respite claim for services rendered in the morning and then again that afternoon. Please contact the county to help with this denial.

  4. If the claim was denied in full, submit the claim again as a new claim to WPS. If the claim was partially paid or partially denied, the claim will need to be submitted using a Corrected Claim. Use this link to learn more about submitting a Corrected Claim to WPS.
  5. The process/time-frame from the point of an ISP being updated to reflect needed units or amount to seeing it on the authorization file can take time. Please be patient when expecting to see a revised authorization for the service in question. If you do not see it after two weeks, please contact the county for follow-up on the status of the revised authorization.