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Provider Enrollment Information
 
Express Enrollment
Overview

State and federal laws allow qualified entities to temporarily enroll children, pregnant women, and certain adults in BadgerCare Plus and individuals in Family Planning Only Services when these individuals are determined to be "presumptively eligible" based on preliminary information about family size and income. In Wisconsin, the process of making presumptive eligibility (PE) determinations and temporarily enrolling individuals in these programs is known as Express Enrollment (EE).

Qualified entities may include health care providers, government agencies, and community-based organizations. ForwardHealth refers to providers and partners who meet the criteria to make PE determinations as "qualified providers and partners." There is no fee for applying to become a qualified provider or partner for making PE determinations.

Applicants for Whom Qualified Providers and Partners May Make Presumptive Eligibility Determinations

Qualified hospitals may make PE determinations for children, pregnant women, and certain adults for BadgerCare Plus; they may also make PE determinations for individuals applying for Family Planning Only Services.

Qualified providers may make PE determinations for children and pregnant women for BadgerCare Plus; they may also make PE determinations for individuals applying for Family Planning Only Services.

Qualified partners may only make PE determinations for children.

Becoming a Qualified Hospital for Express Enrollment of Children, Pregnant Women, and Certain Adults in BadgerCare Plus and of Individuals Applying for Family Planning Only Services

Hospitals are required to meet the applicable enrollment criteria to qualify to make PE determinations. Hospitals that qualify to make PE determinations may do so for certain adults, children, pregnant women, and women diagnosed with breast or cervical cancer, as well as for individuals applying for Family Planning Only Services. Hospitals do not need to submit separate provider enrollment applications to be qualified to make PE determinations for each of these populations.

Enrollment Criteria

To be designated as a qualified hospital for making PE determinations, hospitals must meet both of the following requirements:

  • Be enrolled in Wisconsin Medicaid and BadgerCare Plus.
  • Agree, via a one-time attestation, to do the following:
    • Conduct PE determinations internally and only for patients of the hospital (inpatient or outpatient). Hospitals may not delegate their PE determination authority to an outside entity.
    • Only allow hospital staff who have received training on PE policies and procedures to conduct PE determinations.
    • Assist applicants with completion of a full Medicaid and BadgerCare Plus application.
Hospital Enrollment Application

Medicaid-enrolled hospitals interested in making PE determinations may access the online provider enrollment application via their secure ForwardHealth Portal account. The link to the Express Enrollment for Adults provider application is located in the Quick Links box on the right side of the secure Provider home page.

ForwardHealth will notify hospitals in writing whether their application is approved or denied. When an application is approved, ForwardHealth sends the hospital two communications:

  • The approval letter includes a provider number that identifies the hospital as qualified to use the EE tool to temporarily enroll children, pregnant women, and certain adults in BadgerCare Plus and individuals in Family Planning Only Services.
  • An e-mail sent to the hospital's security administrator that includes a one-time-use personal identification number (PIN). Once the security administrator receives the PIN, he or she is able to log in and set up administrative rights for individuals in the agency to begin using the EE application on the ACCESS Web site. The hospital also receives information about where to find instructional materials and information needed to begin using the EE tool.
Becoming a Qualified Provider for Express Enrollment of Children and Pregnant Women in BadgerCare Plus and of Individuals Applying for Family Planning Only Services

Providers are required to meet the applicable enrollment criteria to qualify to make PE determinations. Providers who qualify to make PE determinations for pregnant women are also automatically qualified to make PE determinations for children for BadgerCare Plus and for individuals applying for Family Planning Only Services. Providers do not need to submit separate provider enrollment applications for these programs.

Enrollment Criteria

Providers are required to meet the enrollment criteria to qualify to make PE determinations for pregnant women, which will also qualify them to make PE determinations for children for BadgerCare Plus and for individuals applying for Family Planning Only Services. Providers who do not meet these enrollment criteria may still qualify to make PE determinations for children only. Refer to the following Becoming a Qualified Provider or Partner for Express Enrollment of Children Only in BadgerCare Plus section.

Provider Enrollment Application

Medicaid-enrolled providers interested in making PE determinations for pregnant women may access the online provider enrollment application via their secure ForwardHealth Portal account. The Express Enrollment for Pregnant Women provider application link is located in the Quick Links box on the right side of the secure Provider home page.

ForwardHealth will notify providers in writing whether their application is approved or denied. When an application is approved, ForwardHealth sends the provider two communications:

  • The approval letter includes a provider number that identifies the provider as qualified to use the EE tool to temporarily enroll pregnant women in BadgerCare Plus.
  • An e-mail sent to the provider's security administrator that includes a one-time-use PIN. Once the security administrator receives the PIN, he or she is able to log in and set up administrative rights for individuals in the agency to begin using the EE application on the ACCESS Web site. The provider also receives information about where to find instructional materials and information needed to begin using BadgerCare Plus Express Enrollment.
Becoming a Qualified Provider or Partner for Express Enrollment of Children Only in BadgerCare Plus

State and federal laws allow children younger than age 19 to be temporarily enrolled in BadgerCare Plus. Under these laws, certain qualified providers or partners are allowed to temporarily enroll children based on preliminary information about family income.

Enrollment Criteria

Medicaid-enrolled providers or partners are required to meet the enrollment criteria to qualify to make PE determinations — for children only — for BadgerCare Plus.

Provider Enrollment Application

Medicaid-enrolled providers or partners interested in making PE determinations — for children only — for BadgerCare Plus may access the online provider enrollment application via their secure ForwardHealth Portal account. The Express Enrollment for Children provider application link is located in the Quick Links box on the right side of the secure Provider home page.

Partners who do not have a secure Portal account may access the application from the Portal home page.

Note: Interested partners may only make PE determinations for children; they may not make PE determinations for pregnant women for BadgerCare Plus or for individuals applying for Family Planning Only Services.

ForwardHealth will notify providers or partners in writing whether their application is approved or denied. When an application is approved, ForwardHealth sends the provider or partner two communications:

  • The approval letter includes a provider/partner number that identifies the provider or partner as qualified to use the EE tool to temporarily enroll children in BadgerCare Plus.
  • An e-mail sent to the provider's or partner's security administrator that includes a one-time-use PIN. Once the security administrator receives the PIN, he or she is able to log in and set up administrative rights for individuals in the agency to begin using the EE application on the ACCESS Web site. The provider or partner also receives information about where to find instructional materials and information needed to begin using BadgerCare Plus Express Enrollment.
Reporting a Change of Address

Express Enrollment providers are required to notify ForwardHealth of a change in their address by completing the online Express Enrollment Change of Address. Reporting a change of address using the online Express Enrollment Change of Address will only update the information ForwardHealth has on file for EE programs; it will not update a provider's address information on file for other ForwardHealth programs. Changes of address for other ForwardHealth programs must be reported using the demographic maintenance tool.

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