Home Eligible

A service that is considered an encounter when performed in a CHC location is also considered an encounter when performed by a CHC provider in one of the following locations:

• Mobile units
• School visits
• Hospitals
• Members’ homes
• Extended care facilities
• Primary sites of identified contracted clinicians

Any services provided to CHC members through referrals to a provider with whom the CHC has no contractual relationship and in which funding for the services is not borne by the CHC is not a CHC service or encounter.

All services provided as part of the CHC encounter must meet all applicable ForwardHealth program requirements, including, but not limited to, medical necessity, PA, claims submission, prescription requirements, and documentation requirements; however, all CHC services reimbursed under the PPS rate structure are exempt from member cost share and copayment requirements.

CHCs will identify encounters by indicating HCPCS procedure code T1015 (Clinic visit/encounter, all-inclusive) on claims for services rendered. ForwardHealth will assign the appropriate encounter type to the claim detail associated with procedure code T1015 based on the provider type of the rendering provider.

SOURCE: WI ForwardHealth Online Handbook Community Health Center Encounters, (Accessed Aug. 2025).