Wisconsin Medicaid Now Denies Incomplete ABA Prior Auths Instead of Holding Them

Wisconsin Medicaid changed its prior authorization process on August 17, 2026, and the changes are in force. ForwardHealth Update 2026-19: “ForwardHealth will deny incomplete PA requests.” Before, it “would hold an incomplete, returned, or pending PA for 30 days to allow providers to send more information.”

The turn: the denial isn't clinical, but the lost days can be real

ForwardHealth says these “are not denied based on medical necessity.” But backdating now has a clock: “Providers must submit the request within 14 days of the requested start date unless they meet the extraordinary circumstances criteria.” By the Update's own terms, a request denied as incomplete and resubmitted after day 14 can't be backdated to the original start. The weeks of treatment in between go unauthorized.

What changed

• Incomplete requests are denied, and extensions to pending submission timeframes “are no longer allowed.”
• Backdating applies to initial and renewal requests within 14 days, never to amendments.
• Amendments to extend treatment must be received before the current PA expires.
• Requests and decision letters go through the ForwardHealth Portal only. Fax and mail ended August 17, and letters are no longer mailed to providers with a Portal account.

For Behavioral Treatment (process type 142) every request needs, per the Update:

• A behavioral treatment prescription and plan of care
• A diagnostic evaluation (members over age 6)
• The provider's initial assessment
• Previous treatment history
• Age-normed testing results
• The behavioral treatment team
• A plan of care with notes on any medical conditions
• A care collaboration plan
• Supporting documentation
• An IEP (members over age 6)
• A schedule for comprehensive standardized testing (members over age 6)
• A diagnostic attestation (initial requests, members under age 6)

The limits

The Update is addressed to “All Providers, HMOs and Other Managed Care Programs” but describes ForwardHealth's own Portal process. If you bill a BadgerCare HMO, confirm its PA rules separately. ForwardHealth says its Online Handbook “has not yet been revised” to match.

What you must know or do

• PA coordinators: turn the 12 items into a pre-submission checklist and don't submit until every one that applies is attached.
• Calendar renewals so they go in before the start date, and amendments before the current PA expires.
• Pull every request denied as incomplete since August 17. Resubmit each one, and for any past day 14, check whether the extraordinary circumstances criteria apply.
• Move any remaining fax workflow to the Portal, and have someone check decision letters there every day.