A provider in a state that either physically borders Wisconsin or who is located in a state that does not physically border Wisconsin but provides only telehealth services 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

Providers may apply for Medicaid enrollment as a border-status provider by completing the Medicaid/Border Status Provider 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 physically borders Wisconsin (Illinois, Iowa, Michigan, and Minnesota)
• Out-of-state providers not located in a state that physically borders Wisconsin who meet the definition of a border-status provider as described in Wis. Admin. Code § DHS 101.03(19) and who provide only telehealth services to Wisconsin members
• All out-of-state independent laboratories, regardless of location in the United States

Note: To be eligible for enrollment as a provider, pharmacists must obtain or have a Wisconsin license before beginning the enrollment process.

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.

Out-of-state providers who do not meet the definition of a border-status provider as described in Wis. Admin. Code § DHS 101.03(19) or who do not provide only telehealth services to Wisconsin members 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.