• Certification
  • Obtaining Certification Packets
    • Introduction
    • Certification for Multiple Services
    • Certification for Multiple Locations
  • Completing Certification Materials
    • Introduction
    • Provider Agreement
    • Terms of Reimbursement
  • Effective Date of Medicaid Certification
    • Introduction
    • Earliest Effective Date
    • Group Certification Effective Dates
    • Request for Change of Effective Date
    • Medicare Enrollment
  • Materials for New Providers
  • Provider Numbers
    • Introduction
    • Billing Performing Provider Number
    • Nonbilling Performing Provider Number
    • Group Billing Numbers
  • Provider Type and Specialty Changes
  • Recertification
    • Introduction
    • Active Recertification
    • Automatic Recertification
  • Reinstating Certification
  • Border-Status Certification
  • Noncertified In-State Providers
  • Out-of-State Providers
  • Out-of-State Youth Program
  • Ending Participation in Wisconsin Medicaid
• Ongoing Responsibilities
  • Introduction
  • Keeping Information Current
    • Introduction
    • Changes in Address or Status
    • Notify the Bureau of Quality Assurance of Changes
  • Change in Ownership
    • Introduction
    • Repayment Following Change in Ownership
  • Documentation Requirements
    • Introduction
    • Reviews and Audits
  • Safeguarding Recipient Confidentiality
  • Release of Billing Information to Government Agencies
  • Records Requests
    • Introduction
    • Requests for Billing Information or Medical Claim Records
    • For More Information
  • Recipient Discrimination Prohibited
  • Accommodating Recipients with Disabilities
  • Allowing Recipient Access to Records
  • Monitoring Contracted Staff
• Provider Rights
  • Introduction
  • Limiting the Number of Recipients
  • Ending Participation in Wisconsin Medicaid
    • Introduction
    • Additional Requirements for Certain Providers
  • Requesting Discretionary Waivers and Variances of Wisconsin Administrative Code Rules
    • Introduction
    • Requirements for a Discretionary Waiver or Variance
    • Application for a Discretionary Waiver or Variance
  • Hearing Requests
• Provider Sanctions
  • Witholding Payments
  • Intermediate Sanctions
  • Involuntary Termination
  • Sanctions for Collecting Payment from Recipients
• Appendix
  • Appendix 1 — Provider Change of Address or Status Completion Instructions
  • Appendix 2 — Provider Change of Address or Status
  • Appendix 3 — Documentation Requirements
  • Appendix 4 — Civil Rights Compliance (Nondiscrimination)
• PDF

Select a section » Certification and Ongoing Responsibilities Claims Information Coordination of Benefits Covered and Noncovered Services Informational Resources Managed Care Prior Authorization Recipient Eligibility

 

 

Certification and Ongoing Responsibilities

Certification

Obtaining Certification Packets

Providers interested in becoming certified by Wisconsin Medicaid are required to complete a certification packet, which includes, but is not limited to, the following:

• General certification information.
• Certification criteria.
• Terms of Reimbursement.
• Provider Application Information and Instructions, HCF 11003.
• Provider Agreement.
• Deletion from Publications Mailing List form, HCF 11015.
• Electronic billing information.

Providers may obtain service-specific Medicaid certification packets from the Provider section of the Medicaid Web site.

Providers without Internet access may request a certification packet(s) by doing one of the following:

• Contacting Provider Services at (800) 947-9627 or (608) 221-9883.
• Sending a request in writing to: Wisconsin Medicaid Provider Maintenance 6406 Bridge Rd Madison WI 53784-0006

Written requests for certification packets must include the following:

• Each applicant’s/provider’s name, address, and telephone number.
• Type of provider (e.g., physician, physician clinic or group, speech-language pathologist, hospital) or the type of services the provider intends to provide.
• The number of certification packets requested and each applicant’s/provider’s name. (A certification packet must be completed for each applicant/provider.)

Note:

Certification materials, including provider agreements, are periodically revised; submission of outdated materials may delay certification.

Next — Certification, Obtaining Certification Packets, Certification for Multiple Services
Previous — Certification