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Welcome  » April 25, 2019 4:48 PM
Provider Enrollment Information
Prescribing/Referring/Ordering Providers
Medicaid Enrollment Requirements for Prescribing/Referring/Ordering Providers

ForwardHealth requires all physicians and other professionals who prescribe, refer, or order services for ForwardHealth members to be enrolled in Wisconsin Medicaid. The following list of providers is required to enroll in Wisconsin Medicaid in order to prescribe, refer, or order services for ForwardHealth members:

  • Chiropractors.
  • Dentists.
  • Mental Health Professionals.
  • Nurse Midwives.
  • Nurse Practitioners.
  • Optometrists.
  • Physician Assistants.
  • Podiatrists.
  • All other Medicaid-enrolled professionals who can prescribe, refer, or order.

Only individual providers may prescribe, refer, or order services. Providers may only prescribe, refer, or order services within their legal scope of practice.

Medicaid Enrollment for Prescribing/Referring/Ordering Providers

Medicaid enrollment specifically for prescribing/referring/ordering providers is available for physicians and other professionals who do not wish to be reimbursed for services provided to ForwardHealth members.

The benefits of the enrollment process for prescribing/referring/ordering providers include the following:

  • Providers do not need to sign a provider agreement.
  • There are fewer panels to complete during the enrollment process, as compared to a full enrollment.
  • Providers only need to complete basic address information along with additional personal data information for persons with an ownership or controlling interest, managing employees, and agents.

Providers interested in enrolling in Wisconsin Medicaid as a prescribing/referring/ordering provider may do so by completing a Medicaid Prescribing/Referring/Ordering Provider Enrollment Application.

Effective Date of Enrollment

The effective date of enrollment as a prescribing/referring/ordering provider is the first date the provider saw a ForwardHealth member and prescribed, referred, or ordered services. (During the enrollment process, providers are required to indicate the date they first saw a ForwardHealth member.) The earliest effective date that can be granted is up to one year in the past from the date the provider's application is submitted.

Limited Risk Level Assigned

All Medicaid-enrolled providers are assigned one of three risk levels (limited, moderate, high) based on provider type. During the enrollment process, ForwardHealth performs certain screening activities based on the provider's risk level assignment. Prescribing/referring/ordering providers are assigned a limited risk level. Refer to Risk Level Classification by Provider Type for screening activities for providers assigned a limited risk level.

Termination of Enrollment Due to Inactivity

If a Medicaid-enrolled prescribing/referring/ordering provider does not prescribe, refer, or order services for any ForwardHealth member for over 12 consecutive months, the provider's Medicaid enrollment may be terminated. The provider will then be required to re-enroll - either using the enrollment process for prescribing/referring/ordering providers or the enrollment process for full Medicaid enrollment.

Full Medicaid Enrollment for Providers Wishing to Render and be Reimbursed for Services

Physicians and other professionals who wish to render and be reimbursed for services as a Medicaid provider are required to apply for full Medicaid enrollment. Providers interested in enrolling fully in Wisconsin Medicaid may do so by completing the standard Medicaid Provider Enrollment Application.

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