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Welcome  » December 6, 2021 11:20 AM
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 members enrolled in Wisconsin Medicaid, BadgerCare Plus, or SeniorCare to be enrolled in Wisconsin Medicaid. This includes the following providers and professionals:

  • 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.

How to Enroll as a Prescribing/Referring/Ordering Provider

Providers who want to enroll in Wisconsin Medicaid as a prescribing/referring/ordering provider may do so by completing a Medicaid Prescribing/Referring/Ordering Provider Enrollment Application. This type of enrollment does not allow Wisconsin Medicaid to reimburse providers for rendering services.

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.

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 for them. (During the enrollment process, providers are required to indicate the date they first saw a ForwardHealth member.) The earliest effective date that ForwardHealth may assign is up to one year in the past from the date the provider's application is submitted.

Limited Risk Level Assigned

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. ForwardHealth typically assigns prescribing/referring/ordering providers a limited risk level. Refer to the Risk Level Classification by Provider Type page 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 more than 12 consecutive months, ForwardHealth may terminate the provider's Medicaid enrollment. 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.

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