Wisconsin Provider Enrollment – Frequently Asked Questions

Note: The information provided within this FAQ page is according to the state, unless otherwise indicated (i.e., some areas indicate “According to CMS/Medicaid”).

For full information regarding Provider Medicaid Enrollment in Wisconsin, please visit the Wisconsin “Forward Health” website, Provider Enrollment Information section.

For answers to general questions, please see the FAQs below.

Who is required to enroll in the state Medicaid program?

  • Individuals
  • Groups
  • Prescribing, Referring, Ordering
  • Border-Status

I am enrolled as a participating provider in another state’s Medicaid program. Am I also required to enroll in Wisconsin’s Medicaid Program to provide services to Medicaid beneficiaries?

Yes.

How do I enroll?

Navigate to the ForwardHealth Wisconsin Portal and complete an online application.

How does my registration relate to billing for services?

You must register with the state using the same identifiers you plan to bill with, i.e., TIN/SSN, Specialty, etc.

The following items must be in alignment:

  • Your contract with Envolve / Centene Dental and Vision
  • State Registration
  • Billing Set Up / Configuration

Are there additional requirements and screenings based on risk / risk level?

According to CMS/Medicaid:

Requirements by Risk Level:

  • All Risk Levels:
    • Verify provider meets any applicable Federal regulations or State requirements for the provider type prior to making an enrollment decision.
    • License Verifications.
    • Conduct Database checks.
  • Limited Risks:
    • Site visit.
  • High Risks:
    • Any provider that has a payment suspension based on a credible allegation of fraud within the last 10 years.
    • Any provider excluded within the past 10 years by HHS-OIG or a State Medicaid Agency (SMA).
    • Any provider that has a qualifying Medicaid overpayment.
    • The provider is enrolling within 6 months of the date of the lifting of a temporary moratorium that at the time would have barred the provider’s enrollment.

States may impose additional screening methods “in addition to or more stringent than” those in the regulations. This could result in a change in the risk category assigned for certain types of providers. Providers should check with their SMA to determine their risk category.

Additional requirements based on Provider’s assigned risk level can be found on the ForwardHealth website under the “Fingerprint Requirement Overview” section.

What is the enrollment application processing timeframe?

Per ForwardHealth, providers will be notified of their enrollment status within ten (10) to sixty (60) business days after receiving the provider’s complete enrollment application.

What is my Enrollment Effective Date? Or How is my Enrollment Effective Date determined?

According to the State, the enrollment effective date is based on the date Wisconsin Medicaid receives the provider’s complete and accurate enrollment application materials.

The date the applicant submits their online provider enrollment application is the earliest effective date possible and will be the effective date if the following are true:

  • Applicant meets all applicable screening requirements, licensure, certification, authorization, or other credential requirements as a prerequisite for Wisconsin Medicaid on the date of submission.
  • Supplemental documents required to enroll have been received within thirty (30) calendar days of the date the applicant submitted the enrollment application. (If required documents are received more than thirty (30) days after the submission of the application, the provider’s enrollment effective date will be the date ForwardHealth receives the last required document.)

For Prescribing, Referring, Ordering Providers: the effective date is the first date the provider saw a ForwardHealth member and prescribed, referred, or ordered services for them.

How do I find proof of registration?

Providers will receive a Welcome Letter and a copy of the Medicaid Provider Agreement.

If an application is denied, the provider will receive written notification of denial and denial reason.

I am enrolled but recently received a letter from the State saying that I need to re-enroll, re-register, or revalidate my information. What do I need to do?

A Revalidation Notice will be sent via US Mail from ForwardHealth when a provider is due to revalidate. Providers have thirty (30) days from their revalidation date to submit their revalidation application.

Re-enrollment: Providers whose Medicaid has ended for any reason other than criminal convictions, sanctions, or failure to be revalidated may be re-enrolled as long as all licensure and enrollment requirements are met. Providers will have to re-enroll as a “new” provider.

How often do I need to re-enroll, re-register, or revalidate my information?

Providers are required to revalidate every three (3) years.

I received a letter from Envolve / Centene Dental and Vision Services about my registration status. What do I do?

Your state provides us with information about each provider’s registration status regularly. We have received information that your registration is not active.

Validate your state registration status to confirm if there are any outstanding items needed to activate your registration. Remember, you’re required to revalidate your information regularly with the state.

If you have proof of current/valid registration, contact us.

Who do I contact if I have questions about my enrollment / registration or need more information?

If any of my information changes, what do I need to do and who do I need to notify?

Keep your information up to date! Any time you have a change to your information, be sure to notify us, as well as log in to your state portal and update!

Here are some examples of the details you should be sure to keep updated:

  • Office Address (including suite number)
  • Office Hours
  • Mailing Address
  • Phone Number

To check the information that Envolve / Centene Dental and Vision has both in our system and published for you, please visit our Find A Provider tool on our website. If you find any discrepancies within the Find A Provider tool data, or if anything needs updating, please contact us to report the issue and update.

Keeping your information current is essential for your practice, to ensure claims are processed appropriately, and for the convenience and satisfaction of our members.