Welcome

The Division of Health Care Financing (DHCF) is pleased to provide you with a copy of the newly revised Wisconsin Medicaid Nurse Practitioner Services Handbook.

The Nurse Practitioner Services Handbook is a guide for all Medicaid-certified nurse practitioners. Providers should maintain and refer to this handbook in conjunction with the Physician Services Handbook, Medicaid All-Provider Handbook, the Wisconsin Medicaid Managed Care Guide, and monthly Wisconsin Medicaid and BadgerCare Updates.

This handbook, in conjunction with the Physician Services Handbook, completely replaces the Nurse Practitioner Handbook that was issued in October 1991 and the following Updates:

Update Number	Update Title
95-08	New health professional shortage areas (HPSAs)
95-14	Contraceptive products
95-16	Transportation policy changes affect referring providers
95-47	IUDs: Reimbursement policy and rate changes
96-03	New tuberculosis (TB) benefit
96-33	CLIA waived tests
96-46	Varicella virus vaccine (Varivax)
97-20	Infant head molding bands
97-39	Coverage of sterotactic computer assisted intracranial procedures
97-41	Medicaid abortion policy
97-44	Clozapine and clozapine management changes
98-01	Lead poisoning: Number one environmental threat to Wisconsin children's health
98-09	Physician office counseling visits and 1995 Wisconsin Act 309
98-15	Prior authorization request changes for home health and personal care agencies
98-29	SMV transportation physician certification form revised
98-33	Wisconsin Medicaid adopts Medicare's diabetic equipment and supplies policy
99-05	Correction to Wisconsin Medicaid's definition of Type II diabetes for purpose of Medicaid coverage
99-18	Change in prescription requirements for billing Medicaid
2000-14	Prior authorization no longer required for selected injection procedure codes
2000-46	Immunization CPT code changes
2000-57	Change in occupational therapy prescription requirements
2001-01	Prospective Drug Utilization Review's impact on prescribers
2001-02	Revision of breast pump coverage
2001-11	"Medicaid Therapy Services for Children" brochure available
2001-24	Allowable Medicaid-covered procedure codes expanded for nurse practitioners
2001-25	Certification required for nurse practitioners
2001-27	Updates to physician services coverage policies and limitations
2001-41	Place of service for nurse practitioners performing home births
2002-01	Medicaid reimbursement for required newborn screening
2002-17	Coverage of anti-emetic drugs
2002-19	Procedure codes eligible to receive the Health Personnel Shortage Area-enhanced reimbursement rate
2002-31	1.095% reimbursement rate increase for non-institutional providers
2002-40	Maximum allowable fee changes for physician services
2002-44	Coverage of Botox^® and Myobloc^®
2002-47	Coverage of critical care and prolonged services revised
2002-53	Wisconsin Medicaid covers procedure code for Lunelle^™
2002-55	Revised policy requirements and procedure codes for breast pumps
2002-56	Procedure code updates
2002-58	Wisconsin Medicaid provides options for providers submitting claims for obstetric services
2002-69	Screenings and diagnostic procedures coverage
2003-01	Wisconsin Medicaid revises Prior Authorization Physician Attachment (PA/PA) (PDF, 66 KB) \| Instructions (PDF, 12 KB)
2003-02	Wisconsin Medicaid revises Provider Certification of Emergency for Undocumented Aliens form (PDF, 57 KB) \| Instructions (PDF, 72 KB)
2003-10	Wisconsin Medicaid revises Newborn Report form (PDF, 25 KB)

Please retain all other service-specific Updates not listed in the table above.

Wisconsin Medicaid will issue revised instructions for completing paper claims and prior authorization (PA) requests, including samples of properly completed forms, effective dates, and information for ordering new forms. These revised instructions will ensure that Wisconsin Medicaid is consistent with the Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

Providers should pay special attention to Wisconsin Medicaid and BadgerCare Updates released in July and August 2003 to keep informed of these important changes. Providers must use the information in these Updates, along with this handbook, to ensure proper claims and PA submission.

The Department of Health and Family Services Web site, dhs.wisconsin.gov/medicaid/, contains additional information for Medicaid providers and an electronic version of the Nurse Practitioner Services Handbook.

We would like to thank everyone who spent time to review the handbook and send comments, including the Wisconsin Nurses Association and the Wisconsin Medical Society.

Wisconsin Medicaid
Nurse Practitioner Services Handbook
PHC 1405, September 2003

TO:	Nurse Practitioners, Clinics, Managed Care Organizations, Rural Health Clinics, Federally Qualified Health Centers
FROM:	Peggy B. Handrich, Associate Administrator Division of Health Care Financing
SUBJECT:	Revised Nurse Practitioner Services Handbook

Wisconsin Medicaid Nurse Practitioner Services Handbook

Previous Medicaid Publications

HIPAA and the Information in This Handbook

Additional Copies of Publications