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Provider Enrollment Information
 
Information for Specific Provider Types

open content close content Ambulance

Enrollment Criteria
Terms of Reimbursement
Risk Level
  • Enrollment: Moderate
  • Revalidation: Moderate
Disclosure Information
Category of Enrollment
  • Billing and Rendering
Border Status
  • Eligible
Other Important Information
  • Ambulance providers who operate an air ambulance or specialized medical vehicle (SMV) require separate enrollment for these services to be eligible for reimbursement.
  • Wisconsin Medicaid requires an air ambulance provider to be licensed by the Division of Health under s. 256.15 (2), Wis. Stats.
Application Fee
  • Yes

open content close content Ambulatory Surgery Centers

Enrollment Criteria
Terms of Reimbursement
Risk Level
  • Enrollment: Limited
  • Revalidation: Limited
Disclosure Information
Category of Enrollment
  • Billing and Rendering
Border Status
  • Eligible
Application Fee
  • Yes

open content close content Anesthetist

Enrollment Criteria
Terms of Reimbursement
Risk Level
  • Enrollment: Limited
  • Revalidation: Limited
Disclosure Information
Category of Enrollment
  • Billing and Rendering
Border Status
  • Eligible
Application Fee
  • No

open content close content Audiologist

Enrollment Criteria
Terms of Reimbursement
Risk Level
  • Enrollment: Limited
  • Revalidation: Limited
Disclosure Information
Category of Enrollment
  • Billing and Rendering
Border Status
  • Eligible
Application Fee
  • No

open content close content Behavioral Treatment

open content close contentBehavioral Treatment Licensed Supervisor

Enrollment Criteria
  • The provider is required to do one of the following:
    • Have a license as a behavior analyst issued by the Wisconsin Department of Safety and Professional Services (DSPS).
    • Have a minimum of 4,000 hours of documented experience as a supervisor of less experienced clinicians delivering the Wisconsin-approved treatment model.

      OR
    • Have a license as a psychiatrist, psychologist, behavior analyst, clinical social worker, professional counselor, or marriage and family therapist issued by the Wisconsin DSPS.
    • Have a minimum of 4,000 hours of documented experience as a supervisor of less experienced clinicians delivering the Wisconsin-approved treatment model.
    • Have a certificate of Early Start Denver Model (ESDM) from the University of California, Davis program.
  • An NPI of Entity Type 1 is Required
Terms of Reimbursement
Risk Level
  • Enrollment: Limited
  • Revalidation: Limited
Disclosure Information
Category of Enrollment
  • Billing and Rendering
Border Status
  • Eligible
Application Fee
  • No
Other Important Information
  • Providers are required to submit to ForwardHealth, via the Portal, a letter or document stating their total hours of experience. This letter or document must be signed by the provider, by a current or prior employer of the provider, or by the provider's supervisor. This required format applies to both documentation of experience delivering treatment and documentation of experience supervising treatment.

open content close contentBehavioral Treatment Therapist

Enrollment Criteria
  • The provider is required to do one of the following:
    • Have a certificate as a Board Certified Assistant Behavior Analyst (BCaBA) issued by the Behavior Analyst Certification Board (BACB).

      OR
    • Have a master's degree from an institution found on the national accreditation database.
    • Have, and attest to, a minimum of 400 hours of documented supervised experience delivering a Wisconsin-approved treatment model.

      OR
    • Have a bachelor's degree from an institution found on the national accreditation database.
    • Have, and attest to, a minimum of 2,000 hours of documented training and supervised experience delivering a Wisconsin-approved treatment model.
Terms of Reimbursement
Risk Level
  • Enrollment: Limited
  • Revalidation: Limited
Disclosure Information
Category of Enrollment
  • Rendering
Border Status
  • Eligible
Application Fee
  • No
Other Important Information
  • Provider enrollment applications for therapists must include the NPI of the therapist's supervisor within the Declaration of Supervision area of the enrollment application on the Portal. The supervisor is required to be Medicaid-enrolled as either a behavioral treatment licensed supervisor or focused treatment licensed supervisor before the therapist's application can be processed.
  • Providers are required to submit to ForwardHealth, via the Portal, a letter or document stating their total hours of experience. This letter or document must be signed by the provider, by a current or prior employer of the provider, or by the provider's supervisor. This required format applies to both documentation of experience delivering treatment and documentation of experience supervising treatment.
  • Therapists who are enrolling under the master's or bachelor's degree qualification are required to submit documentation of degree completion. Documentation can be either a degree or transcript.

open content close contentBehavioral Treatment Technician

Enrollment Criteria
  • The provider is required to do one of the following:
    • Have a high school diploma or a General Educational Development (GED) certificate and have 40 hours of documented training following the standard core curriculum requirements.
    • Have a certificate as a Registered Behavior Technician (RBT) issued by the Behavior Analyst Certification Board (BACB).
Terms of Reimbursement
Risk Level
  • Enrollment: Limited
  • Revalidation: Limited
Disclosure Information
Category of Enrollment
  • Rendering
Border Status
  • Eligible
Application Fee
  • No
Other Important Information
  • Provider enrollment applications for technicians must include the NPI of the technician's supervisor within the Declaration of Supervision area of the enrollment application on the Portal. The supervisor is required to be Medicaid-enrolled as either a behavioral treatment licensed supervisor or focused treatment licensed supervisor before the technician's application can be processed.
  • Providers are required to attest to completion of high school or the equivalent when completing the enrollment application. Providers are required to produce documentation upon request from DHS or federal auditors.

open content close contentFocused Treatment Licensed Supervisor

Enrollment Criteria
  • The provider is required to do one of the following:
    • Have a license as a psychiatrist, psychologist, behavior analyst, clinical social worker, professional counselor, or marriage and family therapist issued by the Wisconsin Department of Safety and Professional Services (DSPS).
    • Have a minimum of 2,000 hours of documented supervised experience delivering a Wisconsin-approved focused treatment model.
  • An NPI of Entity Type 1 is Required
Terms of Reimbursement
Risk Level
  • Enrollment: Limited
  • Revalidation: Limited
Disclosure Information
Category of Enrollment
  • Billing and Rendering
Border Status
  • Eligible
Application Fee
  • No
Other Important Information
  • Providers are required to submit to ForwardHealth, via the Portal, a letter or document stating their total hours of experience. This letter or document must be signed by the provider, by a current or prior employer of the provider, or by the provider's supervisor. This required format applies to both documentation of experience delivering treatment and documentation of experience supervising treatment.

open content close contentFocused Treatment Therapist

Enrollment Criteria
  • The provider is required to do one of the following:
    • o Have a certification as a Board Certified Assistant Behavior Analyst (BCaBA) issued by the Behavior Analyst Certification Board (BACB).

      OR
    • Have a master's degree from an institution found on the national accreditation database.
    • Have, and attest to, a minimum of 400 hours of documented training and supervised experience delivering a Wisconsin-approved treatment model.

      OR
    • Have a bachelor's degree from an institution found on the national accreditation database.
    • Have, and attest to, a minimum of 2,000 hours of documented training and supervised experience delivering a Wisconsin-approved treatment model.

      OR
    • Have a certificate as a Registered Behavior Technician (RBT) issued by the BACB.
    • Have, and attest to, a minimum of 2,000 hours of documented training and supervised experience delivering a Wisconsin-approved treatment model.
Terms of Reimbursement
Risk Level
  • Enrollment: Limited
  • Revalidation: Limited
Disclosure Information
Category of Enrollment
  • Rendering
Border Status
  • Eligible
Application Fee
  • No
Other Important Information
  • Provider enrollment applications for therapists must include the NPI of the therapist's supervisor within the Declaration of Supervision area of the enrollment application on the Portal. The supervisor is required to be Medicaid-enrolled as either a behavioral treatment licensed supervisor or focused treatment licensed supervisor before the therapist's application can be processed.
  • Providers are required to submit to ForwardHealth, via the Portal, a letter or document stating their total hours of experience. This letter or document must be signed by the provider, by a current or prior employer of the provider, or by the provider's supervisor. This required format applies to both documentation of experience delivering treatment and documentation of experience supervising treatment.
  • Therapists who are enrolling under the master's or bachelor's degree qualification are required to submit documentation of degree completion. Documentation can be either a degree or transcript.

open content close content Case Management

Enrollment Criteria
Terms of Reimbursement
Risk Level
  • Enrollment: Limited
  • Revalidation: Limited
Disclosure Information
Category of Enrollment
  • Billing and Rendering
Border Status
  • Not eligible
Other Important Information
  • The following private, nonprofit entities are eligible for enrollment:
    • Independent Living Centers, as defined under s. 46.96(1)(ah), Wis. Stats.
    • Private, nonprofit agencies funded by the DHS under s. 252.12(2)(a)8, Wis. Stats., for purposes of providing life care services to persons diagnosed as having HIV.
Application Fee
  • Yes

open content close content Chiropractor

Enrollment Criteria
Terms of Reimbursement
Risk Level
  • Enrollment: Limited
  • Revalidation: Limited
Disclosure Information
Category of Enrollment
  • Billing and Rendering
Border Status
  • Eligible
Application Fee
  • No

open content close content Community Recovery Services

Enrollment Criteria
  • Must be a local county or tribal agency with Division of Mental Health and Substance Abuse Services (DMHSAS) Certification.
  • An NPI of Entity Type 2 is Required
Terms of Reimbursement
Risk Level
  • Enrollment: Limited
  • Revalidation: Limited
Disclosure Information
Category of Enrollment
  • Billing and Rendering
Border Status
  • Not eligible
Application Fee
  • Yes

open content close content Dental

Enrollment Criteria
Terms of Reimbursement
Risk Level
  • Enrollment: Limited
  • Revalidation: Limited
Disclosure Information
Category of Enrollment
  • Billing and Rendering
Border Status
  • Eligible
Application Fee
  • No

open content close content End Stage Renal Disease

Enrollment Criteria
Terms of Reimbursement
Risk Level
  • Enrollment: Limited
  • Revalidation: Limited
Disclosure Information
Category of Enrollment
  • Billing and Rendering
Border Status
  • Not eligible
Other Important Information
  • With the exception of a limited number of emergency dialysis treatments, hospital providers are required to be separately enrolled as a Medicaid ESRD provider with a specialty of "hospital affiliated" to receive reimbursement for renal disease-related services provided to a member enrolled in BadgerCare Plus or Medicaid.
Application Fee
  • Yes

open content close content Family Planning Clinic

Enrollment Criteria
Terms of Reimbursement
Risk Level
  • Enrollment: Moderate
  • Revalidation: Moderate
Disclosure Information
Category of Enrollment
  • Billing and Rendering
Border Status
  • Not eligible
Application Fee
  • Yes

open content close content Federally Qualified Health Center

Enrollment Criteria
  • To qualify for Medicaid FQHC enrollment, the applicant must provide documentation that they are either designated by the United States Department of Health and Human Services (HHS) as an FQHC or that it receives funds under the Indian Self-Determination Act (Public Law 93-638):
    1. An HHS FQHC is a community health center (CHC), migrant health center, or health care for the homeless program, which meets one of the following:
      1. Receives a grant under the Public Health Service Act, Section 329, 330, or 340;
      2. Has been designated by the Secretary of the HHS as a facility that meets the requirements of receiving a grant (FQHC Look Alike); or
      3. Has been granted a temporary waiver of the grant requirements by the Secretary of the HHS.
    2. An Indian Self-Determination Act FQHC is an outpatient health program or facility operated by a tribe or tribal organization receiving funds under the Indian Self-Determination Act.
  • An NPI of Entity Type 2 is required.
Terms of Reimbursement
Risk Level
  • Enrollment: Limited
  • Revalidation: Limited
Disclosure Information
Category of Enrollment
  • Billing
Border Status
  • Not eligible
Other Important Information
  • Non-Tribal FQHC providers (CHCs) must be associated to an active CHC Group Site. This relationship should be disclosed during the enrollment application flow.
Application Fee
  • Yes

open content close content HealthCheck

open content close contentHealthcheck

Enrollment Criteria
Terms of Reimbursement
Risk Level
  • Enrollment: Limited
  • Revalidation: Limited
Disclosure Information
Category of Enrollment
  • Billing and Rendering
Border Status
  • Eligible
Other Important Information
  • Medicaid-enrolled primary care physicians, certified pediatric nurses, or family nurse practitioners are automatically enrolled for HealthCheck. Other physician specialties, physician assistants, and nurse practitioners are encouraged to request enrollment as HealthCheck providers. Public health agencies and certain other providers, where physician supervision is available, may apply for enrollment as a HealthCheck agency.
Additional Documents
Application Fee
  • Organizations - Yes
  • Individuals - No

open content close contentPediatric Community Care

Risk Level
  • Enrollment: Limited
  • Revalidation: Limited
Disclosure Information
Category of Enrollment
  • Billing and Rendering
Border Status
  • Eligible
Other Important Information
  • State approval is required for enrollment.
Application Fee
  • Yes

open content close contentResidential Community Care

Risk Level
  • Enrollment: Limited
  • Revalidation: Limited
Disclosure Information
Category of Enrollment
  • Billing and Rendering
Border Status
  • Eligible
Other Important Information
  • State approval is required for enrollment.
Application Fee
  • Yes

open content close content Hearing Instrument Specialist

Enrollment Criteria
Terms of Reimbursement
Risk Level
  • Enrollment: Limited
  • Revalidation: Limited
Disclosure Information
Category of Enrollment
  • Billing and Rendering
Border Status
  • Eligible
Application Fee
  • No

open content close content Home Health Agency / Personal Care Agency

open content close contentHome Health Agency

Enrollment Criteria
Terms of Reimbursement
Risk Level
  • Enrollment: High
  • Revalidation: Moderate
Disclosure Information
Category of Enrollment
  • Billing and Rendering
Border Status
  • Eligible
Other Important Information
  • Home health agencies planning to bill personal care services in addition to home health services are required to request enrollment for both service areas.
  • No separate enrollment is necessary for a Medicaid-enrolled home health agency to provide private duty nursing (PDN), durable medical equipment (DME), disposal medical supply (DMS), or enteral nutrition products. When providing PDN, DME, DMS, or enteral nutrition products, the home health agency is required to comply with the PA, billing, and other requirements for those products.
  • Medicaid program requirements may not be construed to supersede the provisions for registration or licensure under s. 50.49, Wis. Stats. Refer to the Wisconsin DSPS Web site and the DHS Licensing and Permitting Web site for more information about registration and licensure requirements.
  • Home health agencies are required to report additional information when enrolling in Medicaid in order to ensure appropriate licensing and to prevent waste, fraud, and abuse. Refer to the Online Handbook for more information regarding reporting requirements.
Application Fee
  • Yes

open content close contentPersonal Care Agency

Enrollment Criteria
  • Section DHS 105.17, Wis. Admin. Code
  • To be eligible for Medicaid enrollment as a free-standing personal care agency, you must have Division of Quality Assurance (DQA) provisional approval as a freestanding personal care agency. Your effective date with Wisconsin Medicaid will be the date DQA approves your provisional free-standing certification.
  • No NPI is Required
Terms of Reimbursement
Risk Level
  • Enrollment: High
  • Revalidation: Moderate
Disclosure Information
Category of Enrollment
  • Billing and Rendering
Border Status
  • Not eligible
Other Important Information
  • Providers enrolled as both Home Health and Personal Care Agencies require an NPI of Entity Type 2.
  • Personal care agencies are required to report additional information when enrolling in Medicaid in order to ensure appropriate licensing and to prevent waste, fraud, and abuse. Refer to the Online Handbook for more information regarding reporting requirements.
Application Fee
  • Yes

open content close content Hospice

Enrollment Criteria
Terms of Reimbursement
Risk Level
  • Enrollment: Moderate
  • Revalidation: Moderate
Disclosure Information
Category of Enrollment
  • Billing and Rendering
Border Status
  • Eligible
Application Fee
  • Yes

open content close content Independent Lab

open content close contentIndependent Lab

Enrollment Criteria
Terms of Reimbursement
Risk Level
  • Enrollment: Moderate
  • Revalidation: Moderate
Disclosure Information
Category of Enrollment
  • Billing and Rendering
Border Status
  • Eligible (Note: Independent laboratories may receive border-status enrollment regardless of their location in the United States.)
Application Fee
  • Yes

open content close contentBlood Bank

Enrollment Criteria
Terms of Reimbursement
Risk Level
  • Enrollment: Limited
  • Revalidation: Limited
Disclosure Information
Category of Enrollment
  • Billing and Rendering
Border Status
  • Not eligible
Application Fee
  • Yes

open content close content Individual Medical Supply

Enrollment Criteria
Terms of Reimbursement
Risk Level
  • Enrollment: Limited
  • Revalidation: Limited
Disclosure Information
Category of Enrollment
  • Billing and Rendering
Border Status
  • Eligible
Other Important Information
  • If a medical supply vendor is an individual, an NPI of Entity Type 1 is required. If a medical supply vendor is an organization, an NPI of Entity Type 2 is required. Ensure that each practice location, if there is more than one, has its own unique NPI.
Application Fee
  • Organizations - Yes
  • Individuals - No

open content close content Inpatient / Outpatient Hospital

Enrollment Criteria
Terms of Reimbursement
Risk Level
  • Enrollment: Limited
  • Revalidation: Limited
Disclosure Information
Category of Enrollment
  • Billing and Rendering
Border Status
  • Eligible
Other Important Information
  • Hospitals are asked to provide ForwardHealth with all subpart NPIs they use with other payers, including Medicare. Providers are required to provide ForwardHealth with only those subpart NPIs that represent hospital units that are not separately enrolled in Wisconsin Medicaid. ForwardHealth uses subpart NPIs as additional identifiers that are linked to the hospital's enrollment.

    Once a subpart NPI is on file with Wisconsin Medicaid, a hospital provider may use the subpart NPI as the billing provider on claims. On adjustments, providers are reminded that the billing provider NPI on the original claim and the billing provider NPI on the adjustment must match.

    Providers may add or revise subpart NPI information on file with ForwardHealth using the demographic maintenance tool, which can be accessed through their secure ForwardHealth Portal account. In addition to subpart NPIs, providers may add to or revise the taxonomy codes corresponding to the subpart using this tool. Once submitted, hospital providers may check the demographic maintenance tool periodically to find out whether ForwardHealth has added the subparts to the provider file.

    Subpart NPIs on file with ForwardHealth may be used on claim transactions, PA requests, WiCall, member enrollment verification, provider enrollment, Provider Services inquiries, and the Portal.
Application Fee
  • Yes

open content close content Licensed Midwife

Enrollment Criteria
  • The provider is required to be licensed by the Wisconsin Department of Safety and Professional Services under s. 440.982, Wis. Stats.
  • An NPI of Entity Type 1 is required.
Terms of Reimbursement
Risk Level
  • Enrollment: Limited
  • Revalidation: Limited
Disclosure Information
Category of Enrollment
  • Billing and Rendering
Border Status
  • Eligible
Application Fee
  • No

open content close content Medical Equipment Vendor

Enrollment Criteria
Terms of Reimbursement
Risk Level
  • Enrollment: High
  • Revalidation: Moderate
Disclosure Information
Category of Enrollment
  • Billing and Rendering
Border Status
  • Eligible
Other Important Information
  • If a DME vendor is an individual, an NPI of Entity Type 1 is required. If a DME vendor is an organization, an NPI of Entity Type 2 is required. Ensure that each practice location, if there is more than one, has its own unique NPI.
Application Fee
  • Organizations - Yes
  • Individuals - No

open content close content Mental Health / Substance Abuse Agencies

open content close contentCommunity Support Program

Enrollment Criteria
  • Agencies are required to obtain a Wisconsin DHS certificate to provide community support program services as authorized under DHS 63, Wis. Admin. Code (which meets Wisconsin Medicaid's DHS 105, Wis. Admin. Code. Agencies that do not meet this criteria will qualify as a 'biller only' provider and will be allowed to bill for community support program services.

    An allowable Medicaid rendering provider is required to perform the service.

    The billing agency is required to make available the nonfederal share needed to provide CSP services.
  • An NPI of Entity Type 2 is Required
Terms of Reimbursement
Risk Level
  • Enrollment: Limited
  • Revalidation: Limited
Disclosure Information
Category of Enrollment
  • County/Tribal with DQA Certificate: Billing and Rendering
  • County/Tribal without DQA Certificate: Billing
  • Not County/Tribal but with DQA Certificate: Rendering
  • Please ensure the appropriate provider type and specialty is chosen based on your DQA Certification. For further clarification please contact Provider Services before completing the enrollment process.
Border Status
  • Eligible
Other Important Information
  • Only local county or tribal agencies may be Medicaid-enrolled to bill CSP services.
Application Fee
  • Yes

open content close contentComprehensive Community Services

Enrollment Criteria
  • Regional Providers — Counties or tribes that operate a regional Comprehensive Community Services (CCS) program under one of the four regional service models detailed below. ForwardHealth provides the federal and non-federal share of Medicaid and BadgerCare Plus program costs to non-regional CCS providers.

    To operate a regional CCS program, counties and tribes must first complete the following three steps listed below:
    • Department of Mental Health/Substance Abuse Services (DMHSAS) Approval — Counties and tribes are required to obtain approval of their proposed regional CCS program from the DMHSAS. Through the DMHSAS approval process, the DMHSAS confirms that the proposed regional CCS program meets the requirements of the regional service model under which it will operate.
    • Division of Quality Assurance (DQA) Certification — Counties and tribes that have received DMHSAS approval to operate a regional CCS program under the population-based, multi-county, or 51.42 models are required to obtain a single Department of Health Services (DHS) DQA certification for the regional CCS program. Counties and tribes that have received DMHSAS approval to operate under the shared services model are required to obtain separate DQA certifications for each county or tribe within the region. Through the DQA certification process, the DQA confirms that the proposed regional CCS program meets all requirements within DHS 36, Wis. Admin. Code.
    • Medicaid Enrollment — Following DMHSAS approval and DQA certification, counties and tribes are required to enroll with ForwardHealth in the Medicaid program as a regional CCS provider based on the following requirements for each regional service model:
      • Population-Based Model — The single county or single tribe within the region must enroll.
      • Shared Services Model — Each county or tribe within the region must enroll separately.
      • Multi-County Model — Each county or tribe within the region must enroll separately.
      • 51.42 Model — The 51.42 entity must enroll; individual counties within the 51.42 region do not need to separately enroll.
      Providers who have multiple Medicaid enrollments are required to provide a unique taxonomy on their CCS enrollment.

      Counties and tribes that are already enrolled in the Medicaid program as CCS providers do not need to re-enroll as regional CCS providers but do still need to complete DMHSAS approval and DQA certification. ForwardHealth is notified by the DQA of any changes to the provider's regional CCS program and automatically updates the provider's Medicaid enrollment file.

      Counties and tribes that are not already enrolled in the Medicaid program as CCS providers must complete a Medicaid enrollment application.
  • Non-regional Providers — Counties or tribes that operate a CCS program within their own county or tribe on a non-regional basis. ForwardHealth provides only the federal share of Medicaid and BadgerCare Plus program costs to non-regional CCS providers. Non-regional providers are required to be certified in either of the following ways:
    • The provider is required to be a local county or tribal agency with DMHSAS certification and DHS DQA certification.
    • The agency is required to obtain a Wisconsin DHS certificate to provide comprehensive community services as authorized under DHS 36, Wis. Admin. Code (which meets Wisconsin Medicaid's DHS 105, Wis. Admin. Code, requirement).

      Agencies that do not meet this criteria will qualify as a "biller only" provider and will be allowed to bill for comprehensive community services. An allowable Medicaid rendering provider is required to perform the service.

      The billing agency is required to have an agency resolution stating that the county or tribe agrees to make available the nonfederal share needed to provide comprehensive community services.
  • An NPI of Entity Type 2 is Required
Terms of Reimbursement
Risk Level
  • Enrollment: Limited
  • Revalidation: Limited
Disclosure Information
Category of Enrollment
  • Regional Providers — Billing and rendering provider depends on the regional service model under which the CCS program operates:
    • Population Based Model — Billing and rendering provider.
    • Shared Services Model — Billing and rendering provider.
    • Multi-County Model — The lead county/tribe will be the billing and rendering provider. The other county/tribe within the region will be the rendering provider.
    • 51.42 Model — Billing and rendering provider.
  • Non-regional Providers:
    • County/Tribal Agency with DQA Certificate — Billing and rendering provider.
    • County/Tribal Agency without DQA Certificate — Billing provider.
    • Not County/Tribal Agency but with DQA Certificate — Rendering provider.
  • Ensure the appropriate provider type and specialty is chosen based on your DQA certification. For further clarification, please contact Provider Services before completing the enrollment process.
Border Status
  • Eligible
Other Important Information
  • Regional CCS providers are required to operate their CCS programs under one of the following four regional service models defined by the DHS DMHSAS:
    • Population-Based Model — A single county with a population exceeding 350,000 residents that operates a regional CCS program within its own county borders or a single tribe, regardless of population size, that operates a regional CCS program within its tribe.
    • Shared Services Model — Multiple counties/tribes partner together to operate a regional CCS program across their counties/tribes; no lead county or tribe is identified.
    • Multi-County Model — Multiple counties/tribes partner together to operate a regional CCS program across their counties/tribes; a lead county or tribe is identified.
    • 51.42 Model — Multiple counties that have partnered together to form a separate 51.42 legal entity operate a regional CCS program through the 51.42 entity.
  • Only local county or tribal agencies may be Medicaid-enrolled to bill CCS.
Application Fee
  • Yes

open content close contentCrisis Intervention Services

Enrollment Criteria
  • The agency is required to obtain a Wisconsin DHS certificate to provide crisis intervention services as authorized under DHS 34, Subchapter III, Wis. Admin. Code (which meets Wisconsin Medicaid's DHS 105, Wis. Admin. Code, requirement).
    Agencies that do not meet this criteria will qualify as a 'biller only' provider and will be allowed to bill for crisis intervention services. An allowable Medicaid rendering provider is required to perform the service.
    The agency is required to make available the nonfederal share needed to provide crisis intervention services.
  • An NPI of Entity Type 2 is Required
Terms of Reimbursement
Risk Level
  • Enrollment: Limited
  • Revalidation: Limited
Disclosure Information
Category of Enrollment
  • County/Tribal with DQA Certificate: Billing and Rendering
  • County/Tribal without DQA Certificate: Billing
  • Not County/Tribal but with DQA Certificate: Rendering
  • Please ensure the appropriate provider type and specialty is chosen based on your DQA Certification. For further clarification please contact Provider Services before completing the enrollment process.
Border Status
  • Eligible
Other Important Information
  • Only local county or tribal agencies may be Medicaid-enrolled to bill crisis intervention services.
Application Fee
  • Yes

open content close contentDay Treatment Services

Enrollment Criteria
  • Adult Mental Health Day Treatment Services
    The agency is required to obtain a Wisconsin DHS certificate to provide mental health day treatment services as authorized under DHS 61.75, Wis. Admin. Code (which meets Wisconsin Medicaid's DHS 105, Wis. Admin. Code, requirement). Agencies that do not meet this requirement can be a 'biller only' provider for mental health day treatment services. An allowable Medicaid rendering provider is required to perform the service.

    Substance Abuse Day Treatment Services
    The agency is required to obtain a Wisconsin DHS certificate to provide substance abuse day treatment services as authorized under DHS 75.12, Wis. Admin. Code (which meets Wisconsin Medicaid's DHS 105, Wis. Admin. Code, requirement). Agencies that do not meet this requirement can be a 1biller only' provider for substance abuse day treatment services. An allowable Medicaid rendering provider is required to perform the service.

    Child Adolescent Day Treatment Services (HealthCheck "Other Services")
    The agency is required to obtain a Wisconsin DHS certificate to provide child/adolescent day treatment services as authorized under DHS 40, Wis. Admin. Code (which meets Wisconsin Medicaid's DHS 105, Wis. Admin. Code, requirement). Agencies that do not meet this requirement can be a 1biller only1 provider for child adolescent day treatment. An allowable Medicaid rendering provider is required to perform the service.
  • Section DHS 105.24, Wis. Admin. Code
  • An NPI of Entity Type 2 is Required
Terms of Reimbursement
Risk Level
  • Enrollment: Limited
  • Revalidation: Limited
Disclosure Information
Category of Enrollment
  • With DQA Certificate: Billing and Rendering
  • Without DQA Certificate and County/Tribal: Billing
Border Status
  • Eligible
Application Fee
  • Yes

open content close contentIn-Home Mental Health Substance Abuse Treatment Services for Children

Enrollment Criteria
  • The agency is required to obtain a Wisconsin DHS certificate to provide outpatient mental health or substance abuse services as authorized under DHS 61.91-61.98, Wis. Admin. Code, or, in situations where substance abuse counseling is the only service provided, as authorized under DHS 75.13, Wis. Admin. Code (which meets Wisconsin Medicaid's DHS 105, Wis. Admin. Code, requirement). Agency providing the service may qualify as an outpatient mental health clinic billing/rendering provider or outpatient substance abuse clinic billing/rendering provider. The agency billing for the service for an outpatient mental health clinic or to qualify as a 'biller only' provider for an outpatient substance abuse clinic in situations where substance abuse counseling is the only service provided. An allowable Medicaid rendering provider is required to perform the service.
  • Section DHS 105.24, Wis. Admin. Code
  • An NPI of Entity Type 2 is Required
Terms of Reimbursement
Risk Level
  • Enrollment: Limited
  • Revalidation: Limited
Disclosure Information
Category of Enrollment
  • With DQA Certificate: Billing and Rendering
  • Without DQA Certificate: Billing
Border Status
  • Not eligible
Application Fee
  • Yes

open content close contentOutpatient Services

Enrollment Criteria
  • Outpatient Mental Health Services (Evaluation, Psychotherapy, Pharmacologic Management)
    The agency is required to obtain a Wisconsin DHS certificate to provide outpatient mental health services as authorized under DHS 61.91-61.98, Wis. Admin. Code (which meets Wisconsin Medicaid's DHS 105, Wis. Admin. Code, requirement). Agencies that do not meet this requirement can be a 'biller only' provider for outpatient mental health services. An allowable Medicaid rendering provider is required to perform the service. Outpatient hospitals utilizing Master's level therapists are required to be certified as a DQA-certified mental health clinic under DHS 61.91-61.98, Wis. Admin. Code. Only covered services provided by an approved hospital facility are eligible for payment under Wisconsin Medicaid's outpatient hospital payment formula. Wisconsin Medicaid defines "hospital facility" as the physical entity, surveyed and approved by the Division of Quality Assurance (DQA) under ch. 50, Wis. Stats.

    Outpatient Substance Abuse Services
    The agency is required to obtain a Wisconsin DHS certificate to provide outpatient substance abuse services as authorized under DHS 75.13, Wis. Admin. Code (which meets Wisconsin Medicaid's DHS 105, Wis. Admin. Code, requirement). Agencies that do not meet this requirement can be a 'biller only' provider for outpatient substance abuse services. An allowable Medicaid rendering provider is required to perform the service.

    Outpatient Mental Health and/or Substance Abuse Services in the Home or Community for Adults
    The agency is required to obtain a Wisconsin DHS certificate to provide outpatient mental health services as authorized under DHS 61.91-61.98 or 75.13, Wis. Admin. Code (which meets Wisconsin Medicaid's DHS 105, Wis. Admin. Code, requirement). Agencies that do not meet this criteria will qualify as a 'biller only' provider and will be allowed to bill for outpatient mental health and/or substance abuse services in the home or community services. An allowable Medicaid rendering provider is required to perform the service. The agency is required to have an agency resolution stating that the county or tribe agrees to make available the nonfederal share needed to provide outpatient mental health and substance abuse services in the home or community.
  • Section DHS 105.24, Wis. Admin. Code
  • An NPI of Entity Type 2 is Required
Terms of Reimbursement
Risk Level
  • Enrollment: Limited
  • Revalidation: Limited
Disclosure Information
Category of Enrollment
  • With DQA Certificate: Billing and Rendering
  • Local County or Tribal Agency Without DQA Certificate: Billing
Border Status
  • Not eligible
Other Important Information
  • Only local county or tribal agencies may be Medicaid-enrolled to bill outpatient mental health and/or substance abuse services in the home or community.
  • County or tribal agencies providing services to adults in the home or community must submit the agency resolution stating that the local county or tribal agency agrees to make available the non-federal share needed to provide Medicaid mental health and substance abuse outpatient services in a home or community setting.
  • Advanced practice nurse prescribers with a psychiatric specialty and psychiatrists are the only mental health providers who can submit claims for psychotherapy services that include a medical evaluation and management component. Additionally, advanced practice nurse prescribers with a psychiatric specialty are required to be separately enrolled in Medicaid as a nurse practitioner in order to be reimbursed for an evaluation and management service.
Additional Documents
  • Matching Funds Resolution
Application Fee
  • Yes

open content close content Mental Health / Substance Abuse Individual Practitioners

open content close contentAlcohol and Other Drug Abuse (AODA)-Certified Counselor Services

Enrollment Criteria
  • The provider is required to do the following:
    • Work in a clinic certified under DHS 75.13, Wis. Admin. Code, and meet the requirements in DHS 75.02(84)(a) and (b), Wis. Admin. Code (which meets Wisconsin Medicaid's DHS 105, Wis. Admin. Code, requirement).
    • Have a license as a Substance Abuse Counselor, Certified Substance Abuse Counselor, or a Certified Substance Abuse Counselor in-training, issued by the Wisconsin Department of Safety and Professional Services.
  • Section DHS 105.23, Wis. Admin. Code
  • An NPI of Entity Type 1 is Required
Terms of Reimbursement
Risk Level
  • Enrollment: Limited
  • Revalidation: Limited
Disclosure Information
Category of Enrollment
  • Rendering
Border Status
  • Eligible
Application Fee
  • No

open content close contentAdvanced Practice Nurse Prescriber with Psychiatric Specialty

Enrollment Criteria
  • The provider is required to do both of the following:
    • Be licensed as an Advanced Practice Nurse Prescriber by the Wisconsin Department of Safety and Professional Services.
    • Have a certificate issued by the American Nurses Credential Center for one of the following:
      • Adult Psychiatric & Mental Health Nurse Practitioner Certification
      • Family Psychiatric & Mental Health Nurse Practitioner Certification
      • Clinical Nurse Specialist in Adult Psychiatric & Mental Healh Certification
      • Clinical Nurse Specialist in Child/Adolescent Psychiatric & Mental Health Certification
  • Section DHS 105.22, Wis. Admin. Code
  • An NPI of Entity Type 1 is Required
Terms of Reimbursement
Risk Level
  • Enrollment: Limited
  • Revalidation: Limited
Disclosure Information
Category of Enrollment
  • Billing and Rendering
Border Status
  • Eligible
Border Status
  • Advanced practice nurse prescribers with a psychiatric specialty and psychiatrists are the only mental health providers who can submit claims for psychotherapy services that include a medical evaluation and management component. Additionally, advanced practice nurse prescribers with a psychiatric specialty are required to be separately enrolled in Medicaid as a nurse practitioner in order to be reimbursed for an evaluation and management service.
Application Fee
  • No

open content close contentCertified Psychotherapist

Enrollment Criteria
  • The provider is required to do the following:
    • Work in a certified mental health clinic as required under DHS 35, Wis. Admin. Code (which meets Wisconsin Medicaid's DHS 105, Wis. Admin. Code, requirement).
    • Have a certificate as an Advance Practice Social Worker or Independent Social Worker issued by the Wisconsin Department of Safety and Professional Services.
    • In addition, applicant must have a Provider Status Approval Letter issued by the Department of Health Services (DHS) Division of Quality Assurance (DQA).
  • Section DHS 105.22, Wis. Admin. Code
  • An NPI of Entity Type 1 is Required
Terms of Reimbursement
Risk Level
  • Enrollment: Limited
  • Revalidation: Limited
Disclosure Information
Category of Enrollment
  • Rendering
Border Status
  • Eligible
Other Important Information
  • A provider whose practice address is in one of the states that border Wisconsin is considered a border-status provider. To be eligible as a Certified Psychotherapist as a border-status provider with Wisconsin Medicaid, you are required to hold a current Wisconsin license or license from the state in which you are rendering services. In either case, you must also have a provider status approval letter issued by the Wisconsin DHS DQA.
Application Fee
  • No

open content close contentCertified Psychotherapist with Substance Abuse Certification

Enrollment Criteria
  • The provider is required to do the following:
    • Work in a certified clinic and meet the requirements listed under DHS 75.13 or DHS 35, Wis. Admin. Code (which meets Wisconsin Medicaid's DHS 105, Wis. Admin. Code, requirement).
    • Have a certificate as an Advanced Practice Social Worker, Independent Social Worker, or registered nurse with a Master's degree in psychiatric mental health nursing or community mental health nursing, issued by the Wisconsin Department of Regulation and Licensing (DSPS).
    • Have a certificate as a Substance Abuse Counselor, Certified Substance Abuse Counselor, or Substance Abuse Specialty issued by the Wisconsin DSPS.
    • In addition, applicant must have a Provider Status Approval Letter issued by the Department of Health Services (DHS) Division of Quality Assurance (DQA).
  • Section DHS 105.22, Wis. Admin. Code
  • Section DHS 105.23, Wis. Admin. Code
  • An NPI of Entity Type 1 is Required
Terms of Reimbursement
Risk Level
  • Enrollment: Limited
  • Revalidation: Limited
Disclosure Information
Category of Enrollment
  • Rendering
Border Status
  • Eligible
Other Important Information
  • A provider whose practice address is in one of the states that border Wisconsin is considered a border-status provider. To be eligible as a Certified Psychotherapist/Substance Abuse Counselor as a border-status provider with Wisconsin Medicaid, you are required to hold either current Wisconsin licenses or licenses from the state in which you are rendering services for psychotherapy and substance abuse. In either case, in addition, you must also have a provider status approval letter issued by the Wisconsin DHS DQA.
Application Fee
  • No

open content close contentLicensed Psychotherapist

Enrollment Criteria
  • The provider is required to be licensed as a Clinical Social Worker, Marriage and Family Therapist, or Professional Counselor by the Wisconsin Department of Safety and Professional Services.
  • Section DHS 105.22, Wis. Admin. Code
  • An NPI of Entity Type 1 is Required
Terms of Reimbursement
Risk Level
  • Enrollment: Limited
  • Revalidation: Limited
Disclosure Information
Category of Enrollment
  • Billing and Rendering
Border Status
  • Eligible
Other Important Information
  • A provider whose practice address is in one of the states that border Wisconsin is considered a border-status provider. To be eligible as a Licensed Psychotherapist as a border status provider with Wisconsin Medicaid, you are required to hold a current Wisconsin license, as stated above.
Application Fee
  • No

open content close contentLicensed Psychotherapist with Substance Abuse Certification

Enrollment Criteria
  • The provider is required to have both of the following:
    • Be licensed as a Clinical Social Worker, Marriage and Family Therapist, or Professional Counselor by the Wisconsin Department of Safety and Professional Services.
    • Have a certificate as a Substance Abuse Counselor (SAC), Certified Substance Abuse Counselor, or Substance Abuse Specialty issued by the Wisconsin Department of Safety and Professional Services.
  • Section DHS 105.22, Wis. Admin. Code
  • An NPI of Entity Type 1 is Required
Terms of Reimbursement
Risk Level
  • Enrollment: Limited
  • Revalidation: Limited
Disclosure Information
Category of Enrollment
  • Billing and Rendering
Border Status
  • Eligible
Other Important Information
  • A provider whose practice address is in one of the states that border Wisconsin is considered a border-status provider. To be eligible as a Licensed Psychotherapist/Substance Abuse Counselor as a border-status provider with Wisconsin Medicaid, you are required to hold a current Wisconsin license and a Wisconsin SAC certification, above. The SAC can be attached to the psychotherapist license or be a separate license from Wisconsin DSPS.
Application Fee
  • No

open content close contentMaster's Level Nurse with Psychiatric Specialty

Enrollment Criteria
  • The provider is required to do all of the following:
    • Work in a certified mental health clinic as required under DHS 35, Admin. Code (which meets Wisconsin Medicaid's DHS 105, Wis. Admin. Code requirement).
    • Be licensed as a registered nurse by the Wisconsin Department of Safety and Professional Services.
    • Have a Master's degree in psychiatric mental health nursing or community mental health nursing.
    • Applicant must have a Provider Status Approval Letter issued by the Department of Health Services Division of Quality Assurance.
  • Section DHS 105.22, Wis. Admin. Code
  • An NPI of Entity Type 1 is Required
Terms of Reimbursement
Risk Level
  • Enrollment: Limited
  • Revalidation: Limited
Disclosure Information
Category of Enrollment
  • Rendering
Border Status
  • Eligible
Application Fee
  • No

open content close contentPh.D. Psychologist Services

Enrollment Criteria
  • The provider is required to have a license to practice as a psychologist, according to ch. 455, Wis. Stats. This must be at the independent practice level (which meets Wisconsin Medicaid's DHS 105, Wis. Admin. Code requirement).
  • If the effective date of the license is prior to October 1, 1991, the provider is required to have one of the following:
    • A copy of his or her listing in the current National Register of Health Service Providers in Psychology as required under DHS 105, Wis. Admin. Code.
    • A copy of documentation that shows he or she is eligible to be listed in the National Register of Health Service Providers in Psychology. The provider is required to include documentation of a doctorate that meets the National Register/Association of State and Provincial Psychology Boards' "Guidelines for Defining a Doctoral Degree in Psychology" with at least two years (minimum of 3,000 hours) of supervised experience in health service. One year (1,500 hours) must be post-internship, which meets the National Register's "Guidelines for Defining an Internship or Organized Health Service Training Program" as required under DHS 105.22(1)(b), Wis. Admin. Code.
  • Section DHS 105.22, Wis. Admin. Code
  • An NPI of Entity Type 1 is Required
Terms of Reimbursement
Risk Level
  • Enrollment: Limited
  • Revalidation: Limited
Disclosure Information
Category of Enrollment
  • Billing and Rendering
Border Status
  • Eligible
Application Fee
  • No

open content close contentQualified Treatment Trainee

Enrollment Criteria
  • Qualified treatment trainees with a graduate degree, as defined in DHS 35.03(17m)(b), Wis. Admin. Code, are QTTs who meet both of the following criteria:
    • They have a graduate degree from an accredited institution with course work in psychology, counseling, marriage and family therapy, social work, nursing, or a closely related field.
    • They have not yet completed the applicable supervised practice requirements described under ch. MPSW 4, 12, or 16, Wis. Admin. Code, or ch. Psy 2, Wis. Admin. Code, as applicable.
  • To qualify for enrollment in Wisconsin Medicaid, QTTs with a graduate degree must either have a doctoral degree from an accredited institution and be working toward full Wisconsin DSPS licensure as a licensed psychologist or be licensed by the Wisconsin DSPS as one of the following:
    • A marriage and family therapist in training.
    • A professional counselor in training.
    • An advanced practice social worker or certified independent social worker.
  • As a QTT, the provider is working toward his or her 3000 clinical hours to become licensed as a social worker, professional counselor, or marriage and family therapist. Upon completion of his or her 3000 hours, the provider plans to become a licensed clinical social worker, marriage and family therapist, or professional counselor through Wisconsin DSPS and updates his or her provdier status using the demographic maintenance tool, which can be access through his or her secure ForwardHealth Portal account.
  • Section DHS 105.22, Wis. Admin. Code
  • An NPI of Entity Type 1 is Required
Terms of Reimbursement
Risk Level
  • Enrollment: Limited
  • Revalidation: Limited
Disclosure Information
Category of Enrollment
  • Rendering
Border Status
  • Not Eligible
Application Fee
  • No

open content close content Narcotic Treatment Services

open content close contentAgency

Enrollment Criteria
  • The agency is required to obtain a Wisconsin DHS certificate to provider narcotic treatment services for opiate addiction as authorized under DHS 75.15, Wis. Admin. Code (which meets Wisconsin Medicaid's DHS 105, Wis. Admin. Code requirement).
  • An NPI of Entity Type 2 is Required
Terms of Reimbursement
Risk Level
  • Enrollment: Limited
  • Revalidation: Limited
Disclosure Information
Category of Enrollment
  • Billing
Border Status
  • Eligible
Application Fee
  • No

open content close contentIndividual

Enrollment Criteria
  • The provider is required to do the following:
    • Work in a Narcotic Treatment Service certified under DHS 75.15, Wis. Admin. Code (which meets Wisconsin Medicaid's DHS 105, Wis. Admin. Code requirement).
    • Have a state of Wisconsin Registered Nurse License or a state of Wisconsin Practical Nurse License issued by the Wisconsin Department of Safety and Professional Services as required under ch. 441.06 and 441.10, Wis. Stats.
  • An NPI of Entity Type 1 is Required
Terms of Reimbursement
Risk Level
  • Enrollment: Limited
  • Revalidation: Limited
Disclosure Information
Category of Enrollment
  • Rendering
Border Status
  • Eligible
Application Fee
  • No

open content close content Nurse in Independent Practice

open content close contentNurse Midwife

Enrollment Criteria
Terms of Reimbursement
Risk Level
  • Enrollment: Limited
  • Revalidation: Limited
Disclosure Information
Category of Enrollment
  • Billing and Rendering
Border Status
  • Eligible
Additional Documents
Application Fee
  • No

open content close contentRegistered Nurse and Licensed Practical Nurse

Enrollment Criteria
Terms of Reimbursement
Risk Level
  • Enrollment: Limited
  • Revalidation: Limited
Disclosure Information
Category of Enrollment
  • Billing and Rendering
Border Status
  • Eligible
Additional Documents
Application Fee
  • No

open content close contentRespiratory Care Services

Enrollment Criteria
Terms of Reimbursement
Risk Level
  • Enrollment: Limited
  • Revalidation: Limited
Disclosure Information
Category of Enrollment
  • Billing and Rendering
Border Status
  • Eligible
Additional Documents
Application Fee
  • No

open content close content Nurse Practitioner

open content close contentNurse Midwife

Enrollment Criteria
Terms of Reimbursement
Risk Level
  • Enrollment: Limited
  • Revalidation: Limited
Disclosure Information
Category of Enrollment
  • Billing and Rendering
Border Status
  • Eligible
Additional Documents
Application Fee
  • No

open content close contentNurse Practitioner

Enrollment Criteria
Terms of Reimbursement
Risk Level
  • Enrollment: Limited
  • Revalidation: Limited
Disclosure Information
Category of Enrollment
  • Billing and Rendering
Border Status
  • Eligible
Additional Documents
Application Fee
  • No

open content close content Nursing Homes

Enrollment Criteria
Risk Level
  • Enrollment: Limited
  • Revalidation: Limited
Disclosure Information
Category of Enrollment
  • Billing and Rendering
Border Status
  • Not eligible
Other Important Information
Application Fee
  • Yes

open content close content Occupational Therapy Individual Practitioners

open content close contentOccupational Therapist

Enrollment Criteria
Terms of Reimbursement
Risk Level
  • Enrollment: Limited
  • Revalidation: Limited
Disclosure Information
Category of Enrollment
  • Billing and Rendering
Border Status
  • Eligible
Application Fee
  • No

open content close contentOccupational Therapist Assistant

Enrollment Criteria
Terms of Reimbursement
Risk Level
  • Enrollment: Limited
  • Revalidation: Limited
Disclosure Information
Category of Enrollment
  • Rendering
Border Status
  • Eligible
Application Fee
  • No

open content close content Optician

Enrollment Criteria
Terms of Reimbursement
Risk Level
  • Enrollment: Limited
  • Revalidation: Limited
Disclosure Information
Category of Enrollment
  • Billing and Rendering
Border Status
  • Eligible
Application Fee
  • Organizations - Yes
  • Individuals - No

open content close content Optometrist

Enrollment Criteria
Terms of Reimbursement
Risk Level
  • Enrollment: Limited
  • Revalidation: Limited
Disclosure Information
Category of Enrollment
  • Billing and Rendering
Border Status
  • Eligible
Application Fee
  • No

open content close content Pharmacy

Enrollment Criteria
Terms of Reimbursement
Risk Level
  • Enrollment: Limited
  • Revalidation: Limited
Disclosure Information
Category of Enrollment
  • Billing and Rendering
Border Status
  • Eligible
Application Fee
  • Yes

open content close content Physical Therapy Individual Practitioners

open content close contentPhysical Therapist

Enrollment Criteria
Terms of Reimbursement
Risk Level
  • Enrollment: Moderate
  • Revalidation: Moderate
Disclosure Information
Category of Enrollment
  • Billing and Rendering
Border Status
  • Eligible
Application Fee
  • No

open content close contentPhysical Therapist Assistant

Enrollment Criteria
Terms of Reimbursement
Risk Level
  • Enrollment: Limited
  • Revalidation: Limited
Disclosure Information
Category of Enrollment
  • Rendering
Border Status
  • Eligible
Application Fee
  • No

open content close content Physician

Enrollment Criteria
Terms of Reimbursement
Risk Level
  • Enrollment: Limited
  • Revalidation: Limited
Disclosure Information
Category of Enrollment
  • Billing and Rendering
Border Status
  • Eligible
Other Important Information
  • To be enrolled in Wisconsin Medicaid, physicians and residents are required to be licensed to practice medicine and surgery pursuant to ss. 448.05 and 448.07, Wis. Stats., and chs. Med 1, 2, 3, 4, 5, and 14, Wis. Admin. Code.
  • Physicians are asked to identify their practice specialty at the time of Medicaid enrollment. Reimbursement for certain services is limited to physicians with specific specialties.
Additional Documents
Application Fee
  • No

open content close content Physician Assistant

Enrollment Criteria
Terms of Reimbursement
Risk Level
  • Enrollment: Limited
  • Revalidation: Limited
Disclosure Information
Category of Enrollment
  • Rendering
Border Status
  • Eligible
Other Important Information
  • To be Medicaid-enrolled, physician assistants are required to be licensed and registered pursuant to s. 448.05 and 448.07, Wis. Stats., and chs. Med 8 and 14, Wis. Admin. Code. All physician assistants are required to be individually enrolled in Wisconsin Medicaid for their services to be reimbursed.
Additional Documents
Application Fee
  • No

open content close content Podiatrist

Enrollment Criteria
Terms of Reimbursement
Risk Level
  • Enrollment: Limited
  • Revalidation: Limited
Disclosure Information
Category of Enrollment
  • Billing and Rendering
Border Status
  • Eligible
Application Fee
  • No

open content close content Portable X-Ray

Enrollment Criteria
Terms of Reimbursement
Risk Level
  • Enrollment: Moderate
  • Revalidation: Moderate
Disclosure Information
Category of Enrollment
  • Billing and Rendering
Border Status
  • Eligible
Application Fee
  • Yes

open content close content Prenatal Care Coordination

Enrollment Criteria
Terms of Reimbursement
Risk Level
  • Enrollment: High
  • Revalidation: Moderate
Disclosure Information
Category of Enrollment
  • Billing and Rendering
Border Status
  • Not eligible
Additional Documents
  • Resumes for all agency staff required
Application Fee
  • Yes

open content close content Provider Groups

Group Types
  • Anesthetist, Audiologist, Chiropractor, Dentist, Hearing Instrument Specialist, Mental Health & Substance Abuse, Nurse Practitioner, Occupational Therapist, Optometrist, Physical Therapist, Physician, Podiatrist, Speech / Language Pathology, Therapy
Enrollment Criteria
  • Only one group practice can be enrolled per location unless there is a separate National Provider Identifier (NPI) or taxonomy to identify the location where services were performed. Provider group practices do not need to enroll every location from which they provide services. Only those locations responsible for billing are required to be enrolled.
  • A group practice must include two or more Medicaid-enrolled providers within the same provider specialty, except as noted under Other Important Information.
  • An NPI of Entity Type 2 is required.
Terms of Reimbursement
  • See Terms of Reimbursement for the respective individual practitioner.
Risk Level
  • Enrollment: Limited
  • Revalidation: Limited
  • Exception: Physical therapy groups have a risk level of moderate at both enrollment and revalidation
Disclosure Information
Category of Enrollment
  • Billing
Border Status
  • Eligible
Other Important Information
  • A group of practitioners means two or more health care practitioners who practice their profession at a common location (whether or not they share common facilities, common supporting staff, or common equipment).
  • Individual providers within a physician clinic or group practice are required to be Medicaid-enrolled.
  • To be enrolled as a therapy group, there must be two or more combined physical therapists, occupational therapists, and speech-language pathologists enrolled in Wisconsin Medicaid.
  • To be enrolled in a group as a dental hygienist, at least one Medicaid-enrolled dentist must be part of the group.
  • For additional information, see ForwardHealth Update Policy for Provider Group Practice Certification.
  • Provider groups are required to report all individual Medicaid-enrolled providers working for the group to ForwardHealth. This information must be reported during initial enrollment, when revalidating enrollment, and any time a change occurs.
Application Fee
  • No

open content close content Rehabilitation Agencies

Enrollment Criteria
Terms of Reimbursement
Risk Level
  • Enrollment: Limited
  • Revalidation: Limited
Disclosure Information
Category of Enrollment
  • Billing and Rendering
Border Status
  • Eligible
Application Fee
  • Yes

open content close content Rural Health Clinic

Enrollment Criteria
Terms of Reimbursement
Risk Level
  • Enrollment: Limited
  • Revalidation: Limited
Disclosure Information
Category of Enrollment
  • Billing
Border Status
  • Eligible
Application Fee
  • Yes

open content close content School-Based Services

Enrollment Criteria
Terms of Reimbursement
Risk Level
  • Enrollment: Limited
  • Revalidation: Limited
Disclosure Information
Category of Enrollment
  • Billing and Rendering
Border Status
  • Not eligible
Other Important Information
  • Because the Department of Public Instruction (DPI) licenses individual providers in Wisconsin schools only, out-of-state schools are ineligible to apply for Wisconsin Medicaid school-based services (SBS) enrollment.
  • Wisconsin Medicaid requires individual rendering providers to be licensed by the DPI for reimbursement under the SBS benefit, with the exception of nurses. Nurses are not required to obtain a DPI license but are encouraged to do so.
Application Fee
  • Yes

open content close content Specialized Medical Vehicle

Enrollment Criteria
Terms of Reimbursement
Risk Level
  • Enrollment: High
  • Revalidation: Moderate
Disclosure Information
Category of Enrollment
  • Billing and Rendering
Border Status
  • Eligible
Other Important Information
  • All new SMV providers enrolled or re-enrolled after a one year lapse and providers who have a change in ownership will be approved for provisional enrollment during which time an audit will be scheduled. No electronic billing will be approved before the audit is conducted and completed and the provider is granted approval to bill electronically. Provisional enrollment and audit applies to the new owner(s) from a change of ownership. Provisional enrollment varies from temporary enrollment, which is approved for any SMV provider when an insurance binder is sent as documentation before the actual policy is received.
Additional Documents
  • SMV Providers Affidavit (F-11237)
  • Letter of receipt of payment for current vehicle insurance
  • Workers Compensation Insurance Certificate
  • One of the following:
    • Copy of current vehicle Commercial insurance policy
    • Certificate of insurance with schedule of vehicles
  • Copy of current cardiopulmonary resuscitation training completion card or digital certificate from the American Heart Association or the American Red Cross for each driver
Application Fee
  • Yes

open content close content Speech and Hearing Clinic

Enrollment Criteria
Terms of Reimbursement
Risk Level
  • Enrollment: Limited
  • Revalidation: Limited
Disclosure Information
Category of Enrollment
  • Billing
Border Status
  • Eligible
Additional Documents
  • ASHA Certificate
Application Fee
  • Yes

open content close content Speech-Language Pathologist

open content close contentBachelor's Level

Enrollment Criteria
Terms of Reimbursement
Risk Level
  • Enrollment: Limited
  • Revalidation: Limited
Disclosure Information
Category of Enrollment
  • Rendering
Border Status
  • Eligible
Other Important Information
  • Individuals with a Bachelor's degree (B.A. or B.S.) in speech-language pathology may become enrolled as a speech-language pathology nonbilling rendering provider. Speech-language pathology nonbilling providers, also referred to as speech and language pathology provider assistants, are required to submit a copy of their degree transcript.
  • Speech and language pathology provider assistants are required to be under the direct, immediate, on-premises supervision of an American Speech-Language-Hearing Association-certified and Medicaid-enrolled supervisor who is responsible and liable for performance of services delivered in accordance with DHS 107.18(1)(a), Wis. Admin. Code. "Direct, immediate, on-premises supervision" is defined as face-to-face contact between the supervisor and the person being supervised, as necessary, with the supervisor being physically present in the same building when the service is being performed by the person being supervised.
  • Speech and language pathology provider assistants are required to notify Wisconsin Medicaid immediately when they have a change in supervisor, employer, or work address using the demographic maintenance tool, which can be accessed through their secure ForwardHealth Portal account.
Application Fee
  • No

open content close contentMaster's Level

Enrollment Criteria
Terms of Reimbursement
Risk Level
  • Enrollment: Limited
  • Revalidation: Limited
Disclosure Information
Category of Enrollment
  • Billing and Rendering
Border Status
  • Eligible
Application Fee
  • No

open content close content Wisconsin Medicaid Cost Reporting (WIMCR) Regionalization

Enrollment Criteria
  • Wisconsin Medicaid Cost Reporting (WIMCR) Regionalization.
  • Case ManagementWis Admin Code § DHS 105.51.
  • Community Support Program (CSP) — Agencies are required to obtain a Division of Quality Assurance (DQA) certificate to provide community support program services as authorized under Wis. Admin Code ch. DHS 63, which meets Wisconsin Medicaid's requirements under Wis. Admin. Code ch. DHS 105).

    The agency is required to make available the nonfederal share needed to provide CSP services.

  • Crisis Intervention Services — The agency is required to obtain a DQA certificate to provide crisis intervention services as authorized under Wis. Admin. Code § DHS 34, Subchapter III, which meets Wisconsin Medicaid's requirements under Wis. Admin. Code ch. DHS 105.

    The agency is required to make available the nonfederal share needed to provide crisis intervention services.

  • Outpatient Substance Abuse Services — The agency is required to obtain a DQA certificate to provide outpatient substance abuse services as authorized under Wis. Admin. Code § DHS 75.13, which meets Wisconsin Medicaid's requirements under Wis. Admin. Code ch. DHS 105.
  • An NPI of Entity Type 2 is required.
Terms of Reimbursement
Risk Level
  • Enrollment: Limited
  • Revalidation: Limited
Disclosure Information
Category of Enrollment
  • The lead county will be the billing and rendering provider. The other county or counties within the region will be the rendering provider(s).
Border Status
  • Not eligible
Other Important Information
  • Only local county agencies may be Medicaid-enrolled to become WIMCR regions with approval from DHS.
Application Fee
  • Yes

open content close content Women, Infant, and Children Agencies (WIC)

Enrollment Criteria
  • WIC Agencies must be contracted with the Wisconsin Division of Public Health (DPH)
  • An NPI of Entity Type 2 is Required
Terms of Reimbursement
Risk Level
  • Enrollment: Limited
  • Revalidation: Limited
Disclosure Information
Category of Enrollment
  • Billing and Rendering
Border Status
  • Not eligible
Application Fee
  • Yes
 
 
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