Note: In-state emergency provider policy does not apply to adult long-term care (LTC) waiver providers who only serve members or participants in Family Care, Family Care Partnership, Program of All-Inclusive Care for the Elderly (PACE), and IRIS (Include, Respect, I Self-Direct).

ForwardHealth requires all in-state providers who render emergency medical or dental services to BadgerCare Plus, Medicaid, or SeniorCare members to be enrolled in Wisconsin Medicaid.

Emergency medical services are defined in Wis. Admin. Code § DHS 101.03(52) as "those services which are necessary to prevent the death or serious impairment of the health of the individual."

Emergency dental services are immediate services that must be provided to relieve the member from pain, an acute infection, swelling, trismus, fever, or trauma.

In-state emergency providers who only prescribe, refer, or order services should enroll as prescribing/referring/ordering providers by completing a Medicaid Prescribing/Referring/Ordering Provider Enrollment Application.

Providers may apply for Medicaid enrollment as an in-state emergency provider by completing the Medicaid In-State Emergency Enrollment Application.

The effective date of enrollment as an in-state emergency provider is the date the provider rendered the service to the BadgerCare Plus, Medicaid, or SeniorCare member. In-state emergency providers are only Medicaid-enrolled for that date of service. Each time a provider renders emergency services to a BadgerCare Plus, Medicaid, or SeniorCare member, the provider is required to re-enroll as an in-state emergency provider for that date in order to be reimbursed.

ForwardHealth assigns all Medicaid-enrolled providers one of three risk levels (limited, moderate, or high) based on provider type. During the enrollment process, ForwardHealth performs certain screening activities based on the provider's risk level assignment. In-state emergency providers are assigned a limited risk level. Refer to the Risk Level Classification by Provider Type page for screening activities for providers assigned a limited risk level.

Providers who apply for Medicaid enrollment as an in-state emergency provider are assessed an application fee. This fee has been federally mandated and may be adjusted annually.

The provider application fee will only be assessed to provider organizations. A provider will not be required to pay ForwardHealth the application fee if the provider is currently enrolled or is in the process of enrolling in Medicare or another state's Medicaid or Children's Health Insurance Program (CHIP). Instead, ForwardHealth will verify the provider's enrollment in Medicare or with the other state and will confirm that the fee has been paid.

While in-state emergency providers are enrolled in Wisconsin Medicaid, they may not charge BadgerCare Plus, Medicaid, or SeniorCare members directly for services that are covered by Wisconsin Medicaid.

Dentists who routinely provide urgent or emergency services to BadgerCare Plus, Medicaid, or SeniorCare members, such as dentists who receive hospital referrals for urgent or emergency services, should apply for full Medicaid enrollment. Providers may apply for full Medicaid enrollment by completing the Medicaid Provider Enrollment Application.

Note: Dentists who fully enroll in Wisconsin Medicaid but only provide urgent or emergency services may choose to be excluded from the Medicaid dental provider list. Providers should contact Provider Services to request their information be removed.