How to Fill Out and Submit the ForwardHealth Prior Authorization Request Form (F-11018)

Wisconsin providers use the ForwardHealth Prior Authorization Request Form, F-11018, to get Department of Health Services approval before delivering certain services or equipment to Medicaid and BadgerCare Plus members. Download the current fillable PDF from the DHS website,1Wisconsin Department of Health Services. Prior Authorization Request Form (PA/RF), F-11018 complete it with the member and provider identifiers, diagnosis and procedure codes, and a written medical-necessity justification, then send the full packet to ForwardHealth through the portal, by fax, or by mail.

What You Need Before You Start

Pull the following together before you open the PDF. A missing or mismatched entry is the fastest way to have the request returned.

Confirm that each ICD code matches the written description you enter next to it. A code-to-description mismatch is one of the most common reasons a request comes back.

Filling In the Form

The F-11018 runs in a predictable sequence: provider and member identification, then clinical details, then the services being requested. Wisconsin Administrative Code DHS 107.02(3)(d) sets the minimum content every PA request must include: the member’s name, address, and MA number; the provider’s name and number; who is requesting authorization; the attending physician’s diagnosis with the degree of impairment; a description of the service with procedure code and time involved; and a justification for providing the service.4Wisconsin State Legislature. Wisconsin Administrative Code DHS 107.02(3)

The justification field is where most requests are won or lost. Reviewers weigh whether the service is medically necessary, whether less expensive alternatives exist, and whether the requested frequency is appropriate, among other criteria in DHS 107.02(3)(e).4Wisconsin State Legislature. Wisconsin Administrative Code DHS 107.02(3) For durable medical equipment, explain why cheaper options won’t work for this member. For any service, connect the diagnosis to the specific procedure requested. Don’t assume the reviewer will bridge gaps for you.

If a prescription or order supports the request, it must carry the date; the prescriber’s name, address, and MA provider number; the member’s name and MA eligibility number; an evaluation of the service; and the estimated length of time required.4Wisconsin State Legislature. Wisconsin Administrative Code DHS 107.02(3)

Fill in the process type field. ForwardHealth returns PA requests without adjudication when no process type is indicated, which keeps the request from entering the review queue at all.5ForwardHealth. Prior Authorization – Forms and Attachments

Attachment Forms

Some services require an attachment form alongside the PA/RF. Common ones include the PA/Physician Attachment (F-11016) and the PA/Physician-Administered Drug Attachment (F-11034). Ambulance services, for example, require a completed F-11016.6ForwardHealth. Prior Authorization – Forms and Attachments Check the service-specific instructions on ForwardHealth to see which attachments apply. Submitting the PA/RF without a required attachment will get the request returned.

How to Submit

ForwardHealth accepts PA requests through three channels. Electronic submission through the ForwardHealth Portal is the fastest: log into your provider account, go to Prior Authorization, and upload the completed form with the clinical attachments.7ForwardHealth. ForwardHealth Portal

If you’re not using the portal, send the full packet by fax or mail:3ForwardHealth. Prior Authorization Request Form Completion Instructions for Physician Services

  • Fax: 608-221-8616. Use clear headers on every page so sheets stay grouped during intake.
  • Mail: ForwardHealth, Prior Authorization, Ste 88, 313 Blettner Blvd, Madison, WI 53784.

Whichever channel you use, send one complete packet: the F-11018, every required attachment form, and all supporting clinical documentation. A missing piece means a returned request and a restarted clock.

Urgent Requests

When a member’s condition needs a faster decision, call ForwardHealth Provider Services at 800-947-9627 to request expedited handling. Urgent requests generally receive a response within five business days.8Wisconsin Association of Health Care. ForwardHealth Update on Urgent Prior Authorization Requests

What Happens After You Submit

Once ForwardHealth receives the PA/RF, the system assigns a 10-digit PA number.9ForwardHealth. ForwardHealth Prior Authorization Request Form – Section: Prior Authorization Numbers Enter that number on the ForwardHealth Portal to check the status at any point.

Every request lands in one of five statuses:10ForwardHealth. Prior Authorization – Decisions

  • Approved. The service is authorized. The approved procedure code may differ from the one you submitted.
  • Modified. The service is authorized, but something changed: a different procedure code, reduced frequency, or adjusted intensity.
  • Returned. The form was incomplete, inaccurate, or needs more clinical information. A provider review letter explains what to correct, and you have 30 calendar days from the date of that letter to respond. Miss the window and the request goes inactive, forcing a new submission.
  • Denied. The request did not meet ForwardHealth’s criteria. Both provider and member are notified, and the provider’s notice gives the specific reason.
  • Inactive. A returned request that wasn’t answered within 30 days.

If the Request Is Denied or Modified

Only the member, or someone authorized to act on the member’s behalf, can file an appeal. Providers cannot file one themselves, but they can share clinical information with the member and help present the case at a hearing.11ForwardHealth. Appeals

The member has 45 days from the date of the Notice of Appeal Rights letter to file. The appeal is a Request for Fair Hearing submitted to the Division of Hearings and Appeals.12ForwardHealth. Appeals The form or a written request goes to:13Wisconsin Department of Health Services. 23.2 Fair Hearings

  • Mail: Division of Hearings and Appeals, P.O. Box 7875, Madison, WI 53707-7875
  • Fax: 608-264-9885
  • Email: DHAMail@wisconsin.gov

If the member wants the service while the appeal is pending, the provider must tell them upfront that they’ll be personally responsible for payment if the denial stands.12ForwardHealth. Appeals

Avoiding the Mistakes That Return Requests

ForwardHealth’s own guidance warns that failing to supply required information can produce an outright denial, not just a return for correction.5ForwardHealth. Prior Authorization – Forms and Attachments Delivering services that go beyond what was authorized, or that differ significantly from the approved scope, can result in nonpayment of the billing claim.

The errors that produce the most returned requests are mechanical: a blank process type field, an ICD code that doesn’t match its written description, a missing attachment form, or an NPI that doesn’t match the provider name on the form. Build a short checklist from the elements in DHS 107.02(3)(d) and walk it through before you submit. One complete packet reviewed once is always faster than a partial packet reviewed twice.