To be reimbursed for services provided to members enrolled in Wisconsin Medicaid, BadgerCare Plus, or SeniorCare, providers are required to be enrolled in Wisconsin Medicaid as described in Wis. Admin. Code ch. DHS 105.

Providers seeking to provide only telehealth services to members enrolled in Wisconsin Medicaid should choose the enrollment pathway that best matches their circumstances:

• In-State Providers—Providers located in Wisconsin that provide services solely through telehealth should enroll in Medicaid as an in-state provider.
• Border-Status Providers—Providers located in a state that physically borders Wisconsin (that is, Illinois, Iowa, Michigan, and Minnesota) that provide services solely through telehealth should enroll in Wisconsin Medicaid as a border-status provider.
• Out-of-State Providers—Providers located in a state outside Wisconsin, which does not physically border Wisconsin, that provide services solely through telehealth should enroll in Medicaid as a telehealth-only border status provider.

ForwardHealth requires all out-of-state providers who render services to BadgerCare Plus, Medicaid, or SeniorCare members to be enrolled in Wisconsin Medicaid. Additionally, if the provider is delivering any reimbursable telehealth service to a Wisconsin Medicaid member across state lines, the licensing board in the patient's location at the time of contact has jurisdiction, and the provider must comply with all rules and regulations in that state in addition to any federal regulations.

For additional guidance on which enrollment process is appropriate, refer to the Example Scenarios for Telehealth-Only Services Enrollment document.

Note: Wisconsin Medicaid is prohibited from paying providers located outside the United States and its territories, including the District of Columbia, Puerto Rico, the Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa.

Out-of-state providers who meet the definition of a border-status provider as described in Wis. Admin. Code § DHS 101.03(19) and who provide services to Wisconsin members only via telehealth, regardless of provider location, may apply for enrollment as a Wisconsin telehealth-only border-status provider. A provider must be licensed in Wisconsin under applicable Wisconsin statute and administrative code and professionally licensed/certified to provide Wisconsin services as defined by the Wisconsin Department of Safety and Professional Services.

Enrolled border-status providers are subject to the same program requirements as in-state providers, including coverage of services, prior authorization (PA), and claim submission procedures. Out-of-state providers that do not enroll as telehealth-only border-status providers are required to obtain PA from ForwardHealth before providing a non-emergency service.

Certain provider types and provider groups are eligible to enroll as telehealth-only border-status providers and deliver reimbursable services via telehealth. Other provider types and provider groups are not eligible to enroll as telehealth-only border-status providers including providers that render services not eligible for telehealth delivery.

Refer to the Provider Enrollment Information page for provider eligibility information. Providers can select their designated provider type or the Provider Groups listing to see whether or not they are eligible to enroll as a telehealth-only border-status provider.

Note: Providers that are not eligible for telehealth-only border-status enrollment may be eligible to enroll through other processes including in-state, border-status, or out-of-state provider.

Providers will automatically be denied telehealth-only border-status enrollment if they were denied enrollment in their own state, unless they were denied because the services they provide are not a covered benefit in their state.

Providers may apply for Medicaid enrollment as a telehealth-only border-status provider by completing the Medicaid/Telehealth-Only Border Status Provider Enrollment Application.

Note: A provider enrolling as a telehealth-only border-status provider located outside a state that physically borders Wisconsin will need to select "telehealth" as their county in the enrollment drop-down menu and provide their appropriate state information.

Providers that render telehealth-only services in states that physically border Wisconsin (Illinois, Iowa, Michigan, and Minnesota) should select their county as opposed to the "telehealth" option in the enrollment drop-down menu.

A border-state provider who has selected their state and county from the drop-down menu of the Practice Location panel is not barred from delivering telehealth services. These providers would be able to deliver any services, including telehealth, covered under Wisconsin Medicaid.

During the enrollment process, telehealth-only border-status providers must attest to understanding the limitations on the services they are delivering to members in Wisconsin and follow all applicable policies, state and federal rules, regulations, and licensure requirements applicable to claims submitted to the Wisconsin Medicaid agency. Providers must also acknowledge that, as a telehealth-only border-status provider, they may only submit claims for reimbursable services delivered through telehealth; any in-person services are subject to out-of-state provider requirements including PA for services.

Enrolled telehealth-only border-status providers are subject to the same program requirements as in-state providers, including coverage of services, PA, and claim submission procedures.

Program limitations and requirements for telehealth-only border-status providers include the following:

• Border-status providers who are not located in states regularly eligible for border status enrollment (states that physically border Wisconsin, Illinois, Iowa, Michigan, and Minnesota) may only deliver services via telehealth unless they have PA. Regular border-status providers (those that physically border Wisconsin, Illinois, Iowa, Michigan, and Minnesota) may deliver services via telehealth and in-person.
• Telehealth-only border status providers must open a Portal account upon enrollment to conduct business via the Portal including submission of PA requests as necessary.
• Telehealth-only border-status providers are required to follow all applicable laws, policies, and regulations including any related requirements from the state from which they are practicing when delivering services.

Wisconsin Medicaid reimburses providers in accordance with its policies. Refer to the ForwardHealth Online Handbook and interactive maximum allowable fee schedules for additional information on reimbursement amounts for the respective services rendered.