Wisconsin Medicaid enrolls providers in three billing categories. Each billing category has specific designated uses and restrictions. These categories include the following:

• Billing and rendering provider
• Rendering-only provider
• Billing-only provider (including group billing)

Providers should refer to the service-specific information on the Information for Specific Provider Types page to identify which category of enrollment is applicable.

Enrollment as a billing and rendering provider allows providers to identify themselves on claims (and other forms) as either the provider billing for the services or the provider rendering the services.

Enrollment as a rendering-only provider is given to providers who practice under the professional supervision of another provider (for example, physician assistants). Providers with a rendering provider enrollment cannot submit claims to ForwardHealth directly, but they have a reimbursement rate established for their provider type. Claims for services provided by a rendering provider must include the supervising provider or group provider as the billing provider.

Enrollment as a billing-only provider is given to certain provider types when a separate rendering provider is required on claims.

Groups of individual practitioners are enrolled as billing-only providers as an accounting convenience. This allows the group to receive one reimbursement, one Remittance Advice, and the 835 Health Care Claim Payment/Advice Transaction for covered services rendered by individual practitioners within the group.

Providers may not have more than one group practice enrolled in Wisconsin Medicaid with the same zip+4 code address, National Provider Identifier (NPI), and taxonomy code combination. Provider group practices located at the same zip+4 code address are required to differentiate their enrollment using an NPI or taxonomy code that uniquely identifies each group practice.

Individual practitioners within group practices are required to be Medicaid-enrolled because these groups are required to identify the provider who rendered the service on claims. Claims indicating these group billing providers that are submitted without a rendering provider are denied.