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Welcome  » April 25, 2019 4:44 PM
Provider Enrollment Information
Border-Status Providers

A provider in a state that borders Wisconsin may be eligible for enrollment as a border-status provider. Border-status providers may need to verify in writing to Wisconsin Medicaid that it is common practice for members in a particular area of Wisconsin to seek their medical services.

The following are exceptions to this policy:

  • Nursing homes and public entities (e.g., cities, counties) outside Wisconsin are not eligible for border status.
  • All out-of-state independent laboratories are eligible to be border-status providers regardless of location in the United States.

Providers who have been denied Medicaid enrollment in their own state are automatically denied enrollment by Wisconsin Medicaid unless they were denied because the services they provide are not a covered benefit in their state. Enrolled border-status providers are subject to the same program requirements as in-state providers, including coverage of services, prior authorization, and claims submission procedures. Reimbursement is made in accordance with Wisconsin Medicaid policies.

For more information about out-of-state providers, refer to DHS 105.48, Wis. Admin. Code.

If you are a Border Status provider apply through Medicaid Enrollment.

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