WPQC Program Information
Please Note: WI Forward Health implemented the MTM benefit in conjunction with WPQC. The MTM benefit consists of the following types of services:
- Intervention-based services (Level I). These are focused interventions between a pharmacist and a member and are based on the identification and resolution of drug therapy problems. These are not separately billable services under WI Medicaid and Badger Care Plus as of April 1, 2017.
- CMR/A services (Level II). These are private consultation between a pharmacist and a member to review the member’s drug regimen. The member must be approved by WI ForwardHealth as a patient who is at high risk of experiencing medical complications due to his or her drug regimen to receive the CMR/A. The pharmacy requests approval to perform the CMR/A by calling the DAPO Center. In addition to Medicaid enrollment, WPQC pharmacist certification is required to perform and receive reimbursement for CMR/A services. Students are encouraged to ask the WPQC Pharmacy Champion at the clerkship site for directions on how to access the ForwardHealth Push List, which provides a list of high risk Medicaid members. If assistance is needed, please contact the Pharmacy Society of Wisconsin (PSW).
WPQC Intervention-based (Level I) and Comprehensive Medication Review and Assessment (CMR/A) (Level II) Services Overview
- Register to gain access to the Wisconsin Pharmacy Quality Collaborative (WPQC) Web Portal (instructions provided in an email two weeks before start of block). If you are already a Pharmacy Society of Wisconsin (PSW) member, click here to sign in and gain access to the WPQC Web Portal. If you are not a PSW member, click here to set up an account and enroll in WPQC only, free of charge. Complete the WPQC Student Training Course accessible from your PSW User Account (under Account Actions). When you register for WPQC, an instructional email guiding you through the steps to become certified will be sent to you.
- Complete the WPQC Home study Assessment (score ≥70% required to pass), and complete the course evaluation to receive your WPQC certificate. Upload the PDF of your certificate to the course web page.
- Listen to the WPQC webinar posted on the course web page.
Intervention-Based Services (Level I)
- Print and review WPQC Level I Service Definition
- Print and review Appropriate vs. Inappropriate WPQC Intervention Billing Guide
- You may wish to utilize the Level I Workflow Flags to identify patients who qualify
- Perform intervention and document your actions on the Level I and Level II Documentation Forms or via Aprexis Health Solutions (for United Way of Dane County)
- Bill for the intervention (when possible). Of note: Intervention Based Services (Level I) are not separately billable services under WI Medicaid and Badger Care Plus as of April 1 2017
- Keep documentation on file at the pharmacy.
- The clinical instructor will initial the online grading record verifying the student completed the assignment.
Comprehensive Medication Review and Assessment (CMR/A) Services (Level II) Process
A CMR/A is a 45 minute to 1-hour sit down face-to-face “medication check-up” appointment with eligible patients.
- Print Checklist for Comprehensive Medication Review and Assessment
- With your preceptor, identify patients who are eligible for a CMR/A.
- Contact patient to schedule appointment to complete a CMR/A. You may wish to utilize the starter phrases and invitation strategies documents to guide your conversation.
- If possible, you may wish to give the patient the What to Bring Document and Health History forms.
- Review the patient’s profile, requesting pertinent lab data from the physician or obtaining from electronic health record (if possible), when needed.
- Complete the CMR/A using a customized outline from the Checklist for Comprehensive Medication Review and Assessment. Use the Level II Documentation Form to document the Level II services and related interventions that were identified.
- Document the encounter. This may be done in the format of a SOAP note as per site requirements.
- Contact the patient’s health care provider with any recommendations. You may wish to use the CMR/A Cover Sheet as a tool.
- Complete a Medication Action Plan (MAP) and provide to the patient. (If using Aprexis, it is built into the system.)
- Complete a Personal Medication List (PML) and provide to patient. (If using Aprexis, it is built into the system.)
- Bill for the intervention (when possible).
- Keep documentation o file at the pharmacy.
- The clinical instructor will initial the online grading record verifying the student completed the assignment.
Billing Resources
Wisconsin ForwardHealth
Several resources exist for billing Wisconsin ForwardHealth. The full resource page of the Wisconsin ForwardHealth MTM Billing is found here. Below are a few resources from the page that may be the most beneficial.
- WI ForwardHealth Provider Handbook
- Submitting Claims via ForwardHealth Portal (general)
- Quick Reference Guide for Billing Level II
- Information to Collect When Submitting DHS MTM Claims (A quick billing reference that can be written on and batch billed at a later time)
- Common Diagnosis Codes
- How to Bill and Document in the WI ForwardHealth Portal (30 minute webinar by Boscobel Pharmacy)
- How to download the ForwardHealth Push List
Additional Payer Billing Resources