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Limited Medicaid enrollment opportunity available for prescribing, ordering physicians

Beginning July 15, 2013, FowardHealth required all physicians and other professionals who prescribe, refer, or order services for ForwardHealth members to be enrolled in Wisconsin Medicaid. Physicians and other providers who are not enrolled are now receiving denials of prior authorization requests and claims for services.

The Wisconsin Medical Society has been following this issue (Medigram, August 29, 2013) and has been in touch with the Medicaid agency to seek clarification on behalf of members who have had questions or issues related to this requirement. The policy requires that any physician or other provider who wishes to routinely render and be reimbursed for services as a Medicaid provider must apply for full Medicaid enrollment. A National Provider Identifier (NPI) must be provided on prior authorization requests and claims for services in order to receive reimbursement.

Physicians and other professionals who only wish to prescribe, refer, or order services and are not interested in full Medicaid enrollment have the opportunity to enroll as a prescribing/referring/ordering provider (PRO). This limited Medicaid enrollment process is brief and can be completed by going to the ForwardHealth portal and selecting “Become a Provider” on the left side of the home page.

Limited enrollment as a PRO provider allows a physician to refer/order/prescribe to a downstream provider who is fully enrolled in the Medicaid program and will be paid for the service. The limited enrollment provider will not be reimbursed by the Medicaid program for patient services, but by enrolling will not have claims denied.

ForwardHealth Update 2013-34 and Update 2013-40 provide detailed information on the requirements and enrollment process. If a physician experiences difficulty with the enrollment process, he/she may contact Charmaine Henderson by phone 608.224.6862 or e-mail, or Vicky Murphy at 608.756.1422 or by e-mail with the Medicaid agency for assistance.

Back to February 27, 2014 Medigram