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Provider Enrollment Information
Wisconsin Well Woman Program
Wisconsin Well Woman Program Overview

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.

How to Request a Paper Application

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

Provider Enrollment
313 Blettner Blvd
Madison WI 53784

What to Include in a Written Application Request

Written requests for enrollment materials must include the following:

  • The number of provider applications requested and each applicant's/provider's name, address, and phone 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
Do Not Submit Example Applications or Copy Paper Applications

ForwardHealth assigns an application tracking number to paper provider applications at the time the provider requests the materials. This allows ForwardHealth to efficiently process and track enrollment and assign effective dates.

For the same reason, providers cannot make copies of a single paper provider application and submit them for multiple applicants.

Providers should mail completed enrollment materials to the address indicated on the application cover letter. Mailing enrollment materials to any other ForwardHealth address may delay processing.

How to Notify ForwardHealth of Demographic 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 Are Required to Update Demographic Information for Each Program

If demographic information changes, providers enrolled in multiple programs (for example, 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.

Exceptions for 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 in ownership, and facility closures by calling 608-266-8481. Providers do not need to also notify ForwardHealth because the DQA will inform ForwardHealth of the changes.

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Wisconsin Department of Health Services
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