MedicaidReimbursementMedium impact
ForwardHealth Update 2026-03: Revised Billing for Tribal Federally Qualified Health Centers
Wisconsin ForwardHealth·WI · Family Medicine, Internal Medicine, General Practice +1 more·Claims & Billing
Effective date
Jan 1, 2024
We identified it
Jun 18, 2026
Summary
ForwardHealth (Wisconsin Medicaid) has changed reimbursement for Tribal Federally Qualified Health Centers from a cost-settlement process to either Prospective Payment System (PPS) or All-Inclusive Rate (AIR) options. Tribal FQHCs must now use HCPCS code T1015 for billing encounters and can choose their reimbursement method annually.
Action Required
Tribal FQHC billing teams must: 1) Contact DHS at DHSTRIBALFQHC@dhs.wisconsin.gov to determine when they can start using HCPCS code T1015. 2) Update billing procedures to include T1015 with dental, mental health, or medical service codes for all encounters. 3) Choose between PPS or AIR reimbursement method by December deadline each year when notified by DHS. 4) Submit final cost reports for any services rendered before January 1, 2024.