Medicaid Provider Revalidation

All Medicaid-enrolled providers are required to revalidate their enrollment information every three years to continue their participation with Wisconsin Medicaid. During the revalidation process, providers update their enrollment information and electronically sign the Wisconsin Medicaid Provider Agreement and Acknowledgement of Terms of Participation.

Providers who serve members or participants in Family Care, Family Care Partnership, Program of All-Inclusive Care for the Elderly (PACE), and IRIS (Include, Respect, I Self-Direct) must also sign the Standard Agreement/Acknowledgement of Terms of Participation for Home and Community-Based Waiver Service (Adult Long-Term Care) Providers.

Providers are required to provide additional information for persons with an ownership or controlling interest, managing employees, and agents.

Providers are subject to additional screening activities based on their risk level.

Providers are able to update group member information and group affiliations when revalidating enrollment. As a reminder, group member information must be entered or updated any time a change occurs (for example, a new provider joins or leaves the organization or clinic.) Outside of revalidation, this information can be updated using the demographic maintenance tool.

Providers receive a Provider Revalidation Notice in the mail from ForwardHealth when it is time to undergo revalidation. The Provider Revalidation Notice specifies the provider’s revalidation date. Providers have 30 days from their revalidation date to submit their revalidation application and pay their enrollment application fee, if applicable.

Note: Providers will not be able to revalidate their enrollment prior to their revalidation date or after the 30-day deadline for revalidating.

Providers who fail to submit their revalidation application by the deadline will be terminated from Wisconsin Medicaid. The provider may be required to complete a re-enrollment application and undergo additional screening activities. The provider may be required to pay another application fee. ForwardHealth will not backdate a provider's enrollment to cover enrollment gaps that occur because of failure to revalidate enrollment in a timely manner.

As a reminder, home health, personal care agencies, and prenatal care coordination workers are required to maintain certain personnel information on file with ForwardHealth. Home health, personal care providers, and prenatal care coordination providers should update their personnel information, as necessary, during the revalidation process; they should keep it current on an ongoing basis via the demographic maintenance tool on the Portal.

Providers who do not have a Provider Portal account will need to establish one in order to complete the revalidation process. Establishing a Provider Portal account involves submitting a request on the Portal and receiving a PIN letter in the mail, so providers who need to establish one are encouraged to do so as soon as possible to avoid delays in revalidating their enrollment.

For detailed instructions on establishing a Provider Portal account, providers may refer to the Account User Guide.

To begin the provider revalidation process, providers should follow these steps:

1. Select Login on this page or from the Portal home page to log in to a secure Provider Portal account.
2. Enter the requested login information.
3. Once in a secure Provider Portal account, click the Revalidate Your Provider Enrollment link and enter your National Provider Identifier or Provider ID, Social Security number, federal tax ID number, and zip code.
4. Save the application tracking number (ATN) that you receive once you have submitted your enrollment application through the Portal. The ATN will allow you to check the status of your revalidation.

After submitting the revalidation application, providers may check on the status of their revalidation at any time by logging in to their secure Provider Portal account or by entering their ATN in the Enrollment Tracking Search available on the Portal home page. Providers may also check on the status of their revalidation by contacting Provider Services and giving their ATN.

Providers will see one of the following status responses:

• Approved, which means ForwardHealth has reviewed the revalidation materials and all requirements have been met. ForwardHealth is completing updates to provider files. Once the updates are complete, the provider’s status will be changed to Revalidated.
• Awaiting Additional Info, which means ForwardHealth has reviewed the revalidation materials and has requested additional information from the provider. The provider will receive a letter in the mail from ForwardHealth specifying the additional information needed.
• Denied, which means that the provider’s revalidation has been denied. The provider will receive a termination letter from ForwardHealth. The provider will be required to complete a re-enrollment application and undergo additional screening activities.
• In Process, which means that the revalidation materials are in the process of being reviewed by ForwardHealth.
• Revalidated, which means that the provider has successfully completed revalidation. There are no actions required from the provider.
• Referred to DHS, which means that ForwardHealth has referred the provider revalidation materials to the state Enrollment Specialist for a revalidation determination. The provider will be notified by ForwardHealth if any additional action is required.