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Welcome  » April 25, 2019 5:14 PM
Provider Enrollment Information
Effective Date of Medicaid Enrollment

The initial effective date of a provider's enrollment will be based on the date Wisconsin Medicaid receives the complete and accurate enrollment application materials. An application is considered complete when all required information has been accurately submitted and all supplemental documents have been received by Wisconsin Medicaid. The date the applicant submits his or her online provider enrollment application to Wisconsin Medicaid is the earliest effective date possible and will be the effective date if both of the following are true:

  • The applicant meets all applicable screening requirements, licensure, certification, authorization, or other credential requirements as a prerequisite for Wisconsin Medicaid on the date of submission.
  • Supplemental documents required by Wisconsin Medicaid that were not uploaded as part of the enrollment process are received by Wisconsin Medicaid within 30 calendar days of the date the enrollment application was submitted. To avoid a delay of the enrollment effective date, providers are encouraged to upload documents during the enrollment process.

If Wisconsin Medicaid receives any applicable supplemental documents more than 30 calendar days after the provider submits the enrollment application, the provider's effective date will be the date all supplemental documents are received by Wisconsin Medicaid.

If providers believe their initial enrollment effective date is incorrect, they may request a review of the effective date. The request should include documentation indicating the enrollment criteria that were incorrectly considered. Requests for changes in enrollment effective dates should be sent to Provider Enrollment at the following address:

Provider Enrollment
313 Blettner Blvd
Madison WI 53784

Group Billing

Group billing enrollments are given as a billing convenience. Groups (except providers of mental health services) may submit a written request to obtain group billing enrollment with an enrollment effective date back 365 days from the effective date assigned. Providers should mail requests to backdate group billing enrollment to Provider Enrollment.

Effective Date for Medicare Providers

ForwardHealth requires certain types of providers to be enrolled in Medicare as a condition for Medicaid enrollment. The enrollment process for Medicare is separate from Wisconsin Medicaid's enrollment process. It may be possible for ForwardHealth to assign a Medicaid enrollment effective date that is the same as the Medicare enrollment date.

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Wisconsin Department of Health Services
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