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Welcome  » December 6, 2021 11:04 AM
Provider Enrollment Information
Border-Status Providers

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

How to Become a Border-Status Provider

To become a border-status provider, apply by completing an enrollment application.

Who Is Eligible for Border Status

The following out-of-state providers may be eligible to enroll in Wisconsin Medicaid as border-status providers:

  • Providers in a state that borders Wisconsin
  • All out-of-state independent laboratories, regardless of location in the United States

Who Is Not Eligible for Border Status

Nursing homes and public entities (for example, cities and counties) outside Wisconsin are not eligible for border status.

Providers will be automatically denied border status enrollment when providers were denied enrollment in their own state unless they were denied because the services they provide are not a covered benefit in their state.

Program Requirements for Border-Status Providers

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 for Border-Status Providers

Wisconsin Medicaid reimburses providers in accordance with its policies.

For More Information

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

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