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Provider Enrollment Information
 
Wisconsin Well Woman Program

The Wisconsin Well Woman Program (WWWP) provides breast and cervical cancer screening services to women with little or no health insurance coverage. The WWWP pays for mammograms, Pap tests, certain breast and cervical cancer diagnosis tests, and multiple sclerosis (MS) testing for women with high risk signs of MS. Interested providers may call Provider Services for more information on enrollment for the WWWP.

Providers interested in enrolling in the WWWP may submit a provider application on paper. To request a paper provider application, providers should do one of the following:

  • Contact Provider Services.
  • Click the "Contact Us" link on the Portal and send the request via e-mail.
  • Send a request in writing to the following address:
ForwardHealth
Provider Enrollment
313 Blettner Blvd
Madison WI 53784

Written requests for enrollment materials must include the following:

  • The number of provider applications requested and each applicant's/provider's name, address, and telephone number (a provider application must be completed for each applicant/provider).
  • The provider's National Provider Identifier (for health care providers) that corresponds to the type of application being requested.
  • The program for which enrollment is being requested (the WWWP).
  • The type of provider or the type of services the provider intends to provide.

Paper provider applications are assigned an application tracking number at the time the materials are requested. As a result, examples of the provider application that are available on the ForwardHealth Portal are for reference purposes only. These examples should not be downloaded and submitted to ForwardHealth. For the same reason, providers cannot make copies of a single paper provider application and submit them for multiple applicants. These policies allow ForwardHealth to efficiently process and track enrollment and assign effective dates.

Once completed, providers should mail enrollment materials to the address indicated on the application cover letter. Sending enrollment materials to any other ForwardHealth address may cause a delay.

Notifying ForwardHealth of Changes

Providers are required to notify ForwardHealth of any changes to their demographic information as they occur. ForwardHealth strongly encourages providers enrolled in WWWP to update their demographic information using the demographic maintenance tool. If providers enrolled in WWWP are unable to update their information online, they can complete and mail the Provider File Update Request form, F-00916 (12/13), to ForwardHealth. Alternate versions of this form will not be accepted and will be returned to providers.

Providers Enrolled in Multiple Programs

If demographic information changes, providers enrolled in multiple programs (e.g., Wisconsin Medicaid and WWWP) will need to change the demographic information for each program. By toggling between accounts using the Switch Organization function of the Portal, providers who have a Portal account for each program may change their information for each program using the demographic maintenance tool. The Account User Guide provides specific information about switching organizations.

Providers Licensed or Certified by the Division of Quality Assurance

Providers licensed or certified by the Division of Quality Assurance (DQA) are required to notify the DQA of changes to physical address, changes of ownership, and facility closures by calling (608) 266-8481. Since the DQA will inform ForwardHealth of the changes, providers do not need to also notify ForwardHealth.

 
 
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