Provider Enrollment and Ongoing Responsibilities : Provider Enrollment

Nurse Practitioners

Nurse practitioners who treat ForwardHealth members are required to be Medicaid-enrolled to receive reimbursement. This applies to nurse practitioners whose services are reimbursed under a physician's or clinic's NPI, as well as to those who independently submit claims to ForwardHealth.

Medicaid services performed by nurse practitioners must be within the legal scope of practice as defined under the Wisconsin Board of Nursing licensure or certification. Services performed must be included in the individual nurse practitioner's protocols or a collaborative relationship with a physician as defined by the Board of Nursing.

Most advanced practice nurse prescribers who apply for Medicaid enrollment are enrolled as nurse practitioners (except for non-Master's degree-prepared nurse midwives and certified registered nurse anesthetists).

Pursuant to Board of Nursing Wis. Admin. Code § N 8.10(7), advanced practice nurse prescribers work in a collaborative relationship with a physician. (The collaborative relationship is defined as an advanced practice nurse prescriber works with a physician, "in each other's presence when necessary, to deliver health care services within the scope of the practitioner's professional expertise.")

Advanced practice nurse prescribers who dispense drugs in addition to prescribing them should obtain the appropriate ForwardHealth pharmacy publications. Providers may also call Provider Services for more information.

Medicaid-enrolled nurse practitioners who provide delegated medical care under the general supervision of a physician are required to be supervised only to the extent required pursuant to Board of Nursing Wis. Admin. Code § N 6.02(7). (Chapter N 6 defines general supervision as the regular coordination, direction, and inspection of the practice of another and does not require the physician to be on site.)

Note: Medicaid enrollment is not required for nurse practitioners working in family planning clinics or as psychiatric nurse practitioners/clinical nurse specialists. Family planning clinics and psychiatric nurse practitioners/clinical nurse specialists should refer to their service-specific areas of this Web site for information on covered services and related limitations.

Services provided by registered nurses who do not meet Medicaid nurse practitioner enrollment requirements may be reimbursed as services provided by ancillary providers.

Protocols/Collaborative Agreements

Pursuant to Wis. Admin. Code § N 8.10(7), advanced practice nurse prescribers work in a collaborative relationship with a physician. The advanced practice nurse prescriber and the physician must document this relationship.

Pursuant to the requirements of Wis. Admin. Code § N 6.03(2), nurse practitioners may only perform those delegated medical acts for which there are protocols or written or verbal orders, and which the nurse practitioner is competent to perform based on his or her nursing education, training, or experience. Nurse practitioners may perform delegated medical acts under the general supervision or direction of a physician, podiatrist, dentist, or optometrist. In addition, nurse practitioners are required to consult with a physician, podiatrist, dentist, or optometrist in cases where the nurse practitioner knows or should know a delegated medical act may harm a patient.

For purposes of Medicaid enrollment, no service which is a medical act and is listed as an allowable physician service may be performed without a collaborative practice agreement as required for advanced practice nurse prescribers (pursuant to Wis. Admin. Code § N 8.10(7)) or protocols, and written or verbal orders for other Medicaid-enrolled nurse practitioners pursuant to Wis. Admin. Code § N 6.03(1).