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Provider Enrollment Information
 
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Provider Enrollment Requirements

Providers are required to enroll as Wisconsin Medicaid providers (as described in Wis. Admin. Code ch.DHS 105) in order to be reimbursed for services provided to members or participants in the following programs:

  • Wisconsin Medicaid
  • BadgerCare Plus
  • SeniorCare
  • Family Care
  • Family Care Partnership
  • Program of All-Inclusive Care for the Elderly (PACE)
  • IRIS (Include, Respect, I Self-Direct)
How to Enroll as a Provider

Providers are required to complete an application process. Failure to complete this process will delay completion of enrollment and could result in denial. Providers have 10 calendar days to complete an application on the ForwardHealth Portal once they begin. As part of the enrollment application, providers are required to sign an agreement with the Wisconsin Department of Health Services (DHS).

Providers sign the provider agreement electronically by selecting the box acknowledging and agreeing to the terms of the agreement. By electronically signing the provider agreement, the provider attests that the provider and each person employed by the provider holds all licenses or similar entitlements and meets other requirements specified in Wis. Admin. Code chs. DHS 101-109; the IRIS Waiver; the Family Care Waiver; and any federal or state statute, regulation, or rule for the provision of the service.

How ForwardHealth Uses Personal Information

Personally identifiable information about Medicaid providers, persons with ownership or controlling interest in the provider organization, managing employees, agents, or other personnel is only used for purposes directly related to the administration of Medicaid. Those purposes include decisions related to enrollment, actions monitoring providers for waste, fraud, or abuse. All information provided is protected under federal and/or state confidentiality laws.

Failure to supply the information requested on the application may result in denial of Medicaid payment for the services.

Duration of the Provider Agreement

The provider agreement remains in effect as long as the provider is enrolled with Wisconsin Medicaid.

Termination of Enrollment

A provider's enrollment with Wisconsin Medicaid may be terminated in one of the following ways:

  • By the provider, as specified in Wis. Admin. Code § DHS 106.05
  • By DHS, upon grounds set forth in Wis. Admin. Code § DHS 106.06
 
 
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