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Topic #473

Provider Relations Representatives

The Provider Relations representatives, also known as field representatives, conduct training sessions on various ForwardHealth topics for both large and small groups of providers and billers. In addition to provider education, field representatives are available to assist providers with complex billing and claims processing questions. Field representatives are located throughout the state to offer detailed assistance to all ForwardHealth providers and all ForwardHealth programs.

Field Representative Specialization

The field representatives are assigned to specific regions of the state. In addition, the field representatives have specialized in a group of provider types. This specialization allows the field representatives to most efficiently and effectively address provider inquiries. To better direct inquiries, providers should contact the field representative in their region who specializes in their provider type.

Provider Education

The field representatives' primary focus is provider education. They provide information on ForwardHealth programs and topics in the following ways:

  • Conducting provider training sessions throughout the state.
  • Providing training and information for newly enrolled providers and/or new staff.
  • Participating in professional association meetings.

Providers may also contact the field representatives if there is a specific topic, or topics, on which they would like to have an individualized training session. This could include topics such as use of the Portal (information about claims, enrollment verification, and PA requests on the Portal). Refer to the Providers Trainings page for the latest information on training opportunities.

Additional Inquiries

Providers are encouraged to initially obtain information through the ForwardHealth Portal, WiCall, and Provider Services. If these attempts are not successful, field representatives may be contacted for the following types of inquiries:

  • Claims, including discrepancies regarding enrollment verification and claim processing.
  • PES claims submission software.
  • Claims processing problems that have not been resolved through other channels (e.g., telephone or written correspondence).
  • Referrals by a Provider Services telephone correspondent.
  • Complex issues that require extensive explanation.

Field representatives primarily work outside their offices to provide on-site service; therefore, providers should be prepared to leave a complete message when contacting field representatives, including all pertinent information related to the inquiry. Member inquiries should not be directed to field representatives. Providers should refer members to Member Services.

If contacting a field representative by e-mail, providers should ensure that no individually identifiable health information, known as PHI, is included in the message. PHI can include things such as the member's name combined with his/her identification number or SSN.

Information to Have Ready

Providers or their representatives should have the following information ready when they call:

  • Name or alternate contact.
  • County and city where services are provided.
  • Name of facility or provider whom they are representing.
  • NPI or provider number.
  • Telephone number, including area code.
  • A concise statement outlining concern.
  • Days and times when available.

For questions about a specific claim, providers should also include the following information:

  • Member's name.
  • Member identification number.
  • Claim number.
  • DOS.

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