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Provider Enrollment Information
 
Effective Date of Medicaid Enrollment
How ForwardHealth Determines the Medicaid Enrollment Effective Date

The initial effective date of a provider's enrollment will be based on the date Wisconsin Medicaid receives the provider's 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.

The date the applicant submits their online provider enrollment application is the earliest effective date possible and will be the effective date if 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 to enroll have been received within 30 calendar days of the date the applicant submitted the enrollment application. To avoid a delay of the enrollment effective date, providers are encouraged to upload documents during the enrollment process.

If any applicable supplemental documents are received more than 30 calendar days after the provider submits the enrollment application, the provider's enrollment effective date will be the date that ForwardHealth receives the last applicable supplemental document.

How to Request a Review of the Enrollment Effective Date

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 may have been incorrectly considered. Requests for changes in enrollment effective dates should be uploaded using the demographic maintenance tool or mailed to Provider Enrollment at the following address:

ForwardHealth
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 365 days prior to the originally assigned effective date. Providers should upload requests using the demographic maintenance tool or 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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