Wisconsin splits long-term care across IRIS, Family Care, the Children's Long-Term Support (CLTS) waiver and Medicaid targeted case management, and the state decides who does the coordinating in each. If your agency is one of them, or serves them, One Care Portal runs beside the state's and payers' systems, not in place of them. Compliance Review checks your notes and plans against your own criteria. Billing/RCM tracks claims through 835 payment posting. Case Management runs caseloads where your agency keeps its own working record.
Wisconsin runs several publicly funded long-term care programs. Who may coordinate care is set by the Department of Health Services (DHS), the county, or the managed care organization, so fit depends on your program type, not your size.
Self-directed waiver
Self-directed Medicaid long-term care for adults 18 and older who are older adults or adults with a disability. Participants budget, choose and manage their own services. Each participant works with an IRIS consultant agency (ICA); DHS lists six, under contract. The consultant helps build the plan of care, which must be approved before services start. A fiscal employer agent (FEA) handles payroll and provider invoices.
Managed care
Members choose a managed care organization (MCO). The MCO's interdisciplinary team, with a care manager, assesses needs, writes the member-centered plan and coordinates services. People start with their local Aging and Disability Resource Center (ADRC), which explains the program and eligibility. Agencies serve these programs as MCO-contracted providers.
Children's waiver
A home and community-based waiver for children with disabilities. Support and service coordination is delivered by county waiver agencies or the agencies they subcontract with. Providers register in the CLTS Provider Registry. Prior authorizations and claims run through the ForwardHealth Portal.
State Plan service
Assessment, case plan development and ongoing monitoring and service coordination. It is delivered by certified agencies with state statutory authority to run community human service programs, such as county or tribal departments, and by people under contract to them. The county or tribal government must elect to participate.
Sources: DHS IRIS (index); DHS IRIS consultant agencies; DHS Family Care; DHS CLTS; CLTS Waiver Manual P-02256; IRIS Policy Manual P-00708; ForwardHealth Online Handbook, Targeted Case Management; Wis. Admin. Code DHS 105.51; Wis. Admin. Code DHS 107.32. Read October 2026. DHS and the program manuals control current requirements.
These are minimums the state publishes. Your contracts and counties may ask for more. Whatever the rule, the record has to show it.
Sources: CLTS Waiver Manual P-02256; IRIS Policy Manual P-00708; Family Care/Partnership 2026 MCO contract; Wis. Admin. Code DHS 105.51. Read October 2026. DHS and the program manuals control current requirements.
One Care Portal does not connect to, submit to, or replace any of these. Agencies keep entering what the state requires where the state requires it.
Where CLTS prior authorizations and claims are submitted. A prior authorization is required before a CLTS provider delivers a service and bills. Claims go in by direct entry, from a prior authorization, as 837 files or on paper.
The state system for the Long-Term Care Functional Screen. An ADRC grants an ICA view-only access to a prospective enrollee's screen.
The state system where Income Maintenance agencies determine financial eligibility and calculate cost share.
Participant payroll, timesheets and provider invoices run through the fiscal employer agent. DHS has announced it will move participants to a single FEA starting sometime in 2027.
DHS reviews participant records for ICAs and tracks remediation in its own review site.
Wisconsin requires electronic visit verification for personal care and supportive home care and for listed home health services, through the DHS-provided Sandata system or an approved alternate. One Care Portal does not provide EVV.
Sources: DHS CLTS claims processing; Functional Screen toolkit P-02783N; IRIS Policy Manual P-00708; DHS IRIS FEA announcement; DHS EVV; DHS EVV providers. Read October 2026. DHS and the program manuals control current requirements.
Case Management, Compliance Review and Billing/RCM each work on their own or together. These are existing products configured per agency and per program, not a separate state product. The 835 ERA Dashboard is included within Billing/RCM and is also available on its own.
Keep your current system and put a review layer beside it. Upload visit notes, charts, assessments and plans as PDFs, check them against criteria your agency sets, record each finding as confirmed, dismissed or resolved, and approve, return or escalate the document. Qualified reviewers make the final decisions, and the follow-up history stays with the record.
Explore Compliance ReviewGenerate or import billing data, validate and submit claims through clearinghouse-supported payer workflows, track status, work denials, post 835 ERAs and reconcile remittance advice. Exact payer, plan, transaction, enrollment, and claim-type fit is confirmed during setup. Use it by itself or with Case Management. The 835 ERA Dashboard is available standalone and inside Billing/RCM.
Explore Billing/RCM 835 ERA DashboardRole-scoped caseloads, calendars and visit schedules. A note for every contact with date, time, method, type, location and people present. Problems found at a contact stay open on the next note until someone resolves them. Supervisor review with required-field validation, signatures, attestation, amendments and audit history. Service authorization records and an expiring-authorizations report. Participant and staff documents with expiration dates.
Explore Case ManagementRead October 2026. Check DHS before you rely on any date.
The renewed waiver runs from January 1, 2026 through December 31, 2030. Consultant services were renamed IRIS Consultant Agency Services, with updated competencies and service definitions.
Sources: DHS IRIS waiver renewal. Read October 2026. DHS and the program manuals control current requirements.
DHS posts the 2026 ICA provider agreement, effective January 1, 2026, with a December 2025 amendment.
Sources: DHS IRIS resources. Read October 2026. DHS and the program manuals control current requirements.
DHS announced its notice of intent on January 29, 2026 and says participants will begin transferring to one FEA sometime in 2027. Check DHS for protest status and the transition schedule.
Sources: DHS IRIS FEA announcement. Read October 2026. DHS and the program manuals control current requirements.
DHS describes additional Family Care choices beginning in 2027. Partnership expansion depends on CMS approval and may extend beyond 2027. Members need no action now.
Sources: DHS Family Care What's New. Read October 2026. DHS and the program manuals control current requirements.
CLTS prior authorizations and claims run through the ForwardHealth Portal. Confirm current submission requirements with DHS.
Sources: DHS CLTS claims processing. Read October 2026. DHS and the program manuals control current requirements.
Hard launch for personal care and supportive home care began May 1, 2023. Home health services and code 99509 followed October 1, 2024.
Sources: DHS EVV. Read October 2026. DHS and the program manuals control current requirements.
The CLTS Waiver Manual is dated April 2026 and the IRIS Policy Manual June 2026.
Sources: CLTS Waiver Manual P-02256; IRIS Policy Manual P-00708. Read October 2026. DHS and the program manuals control current requirements.
That is set by Wisconsin, not by One Care Portal. DHS contracts with a limited set of IRIS consultant agencies, and CLTS support and service coordination is limited to county waiver agencies and the entities they subcontract with. If you already work in one of those lanes, or provide services in these programs, we can show you where the products fit.
No. It is your agency's working system for review, follow-up and billing status. Anything Wisconsin requires in a state system is still entered there.
No. Wisconsin requires EVV for personal care, supportive home care and listed home health services through the DHS-provided system or an approved alternate. One Care Portal does not provide EVV.
Yes. Compliance Review works on PDFs from the system you have to keep. Case Management and Billing/RCM are separate, and you can add them later.
Billing/RCM submits claims through clearinghouse-supported payer workflows and posts 835s. Exact payer, plan, transaction, enrollment, and claim-type fit is confirmed during setup, so tell us whether you bill ForwardHealth fee-for-service, an MCO or a county.
Tell us which programs you serve and bring a blank note template or a sample review checklist. In 30 minutes we show Compliance Review, Billing/RCM and Case Management, and say plainly what would need configuration.
Do not submit participant names, records, or other PHI through the booking form.
