In accordance with the Affordable Care Act (ACA), providers classified as high risk during Medicaid enrollment, re-enrollment, or revalidation are required to be fingerprinted. This requirement applies to high-risk providers, as well as any person with a 5 percent or more direct or indirect ownership interest in the provider. All providers are responsible for identifying any individuals with a 5 percent or more direct or indirect ownership interest to ensure that all appropriate individuals are fingerprinted.

High-risk providers are not required to be fingerprinted if they are enrolled in and have already been fingerprinted as an enrollee in one of the following:

• Another state Medicaid agency
• The Children's Health Insurance Program (CHIP)
• Medicare as a high-risk provider

Exempt providers may submit proof of their exemption (being sure to include their application tracking number [ATN] on the documentation) to ForwardHealth by fax at 608-221-0885 or mail at the following address at any time:

•      ForwardHealth
•      Provider Enrollment
•      313 Blettner Blvd
•      Madison WI 53784

Providers will be denied enrollment or revalidation, as applicable, if they or any person with a 5 percent or more direct or indirect ownership in the provider have been convicted of a criminal offense related to their involvement with Medicare, Medicaid, or CHIP in the last 10 years.

Providers are notified of a high-risk level classification and screening activities, if applicable, via the Fingerprint Notification panel when they submit their Medicaid enrollment, re-enrollment, or revalidation application on the ForwardHealth Portal.

Additional information about the fingerprint-based criminal background check screening is provided within the application process. This includes information about use of the Wisconsin Medicaid Fieldprint code and the ATN, which are required for scheduling appointments to be fingerprinted.

The provider submitting the application is responsible for making any person with a 5 percent or more direct or indirect ownership interest in the provider aware of the required screening activities and sharing the Fieldprint code and the assigned ATN.

All applicable individuals are required to be fingerprinted within 30 calendar days from the Medicaid application submission date, or the application will be denied. ForwardHealth will process the Medicaid application once all fingerprints are submitted. For revalidations, providers are required to be fingerprinted within their revalidation window.

The Wisconsin Department of Administration has contracted with the company Fieldprint to collect fingerprints and submit them to the Wisconsin Department of Justice for processing.

After completing the Medicaid application, high-risk providers, as well as any person with a 5 percent or more direct or indirect ownership interest in the provider, must schedule an appointment by clicking Schedule an Appointment on the Fieldprint website.

Individuals are prompted to create a secure user account and enter information, including the Fieldprint code and their assigned ATN received by the provider who submitted the Medicaid application, via the secure Fieldprint online application. Once complete, individuals may search for a fingerprinting location to schedule an appointment.

Individuals are required to pay a fee of $7.75 for fingerprinting. The fee is collected when the fingerprinting appointment is scheduled with Fieldprint. The fee may be adjusted in the future.

Refer to the Fieldprint FAQs for more information. Providers should contact Fieldprint by phone at 877-614-4364 or via email with any additional questions about the fingerprinting process.

Providers should continue to contact Provider Services for questions about provider enrollment.