Free Certification Criteria for Providers Express Enrollment of Pregnant Women in BadgerCare Plus, F11317 - Wisconsin

FORWARDHEALTH PROVIDER SERVICES 6406 BRIDGE ROAD MADISON WI 53784

Jim Doyle Governor Karen E. Timberlake Secretary

State of Wisconsin Department of Health Services

Telephone: 800-947-9627 TTY: 608-221-4746

www.forwardhealth.wi.gov www.forwardhealth.wi.gov/members

CERTIFICATION CRITERIA For Providers Express Enrollment of Pregnant Women in BadgerCare Plus State and federal laws allow pregnant women to be temporarily enrolled in BadgerCare Plus. Under these laws, certain qualified providers are allowed to temporarily enroll pregnant women using the BadgerCare Plus Express Enrollment tool based on preliminary information about family size and income. To be qualified to enroll pregnant women in BadgerCare Plus, providers must meet the criteria under Items 1 through 3 below: 1. 2. Be certified as a Medicaid provider under Ch. HFS. 105, Wis. Admin. Code; and Provide one or more of the following services: (a) (b) (c) Outpatient hospital services Rural health clinic services; or Clinic services (furnished by or under the direction of a physician, without regard as to whether the clinic itself is administered by a physician); and

3.

Receive funding or participate in a program under: (a) (b) (c) (d) (e) A migrant health center or community health center program (under Section 330 of the Public Health Service Act); A maternal and child health services block grant program (Title V of the Social Security Act); Title V of the Indian Health Care Improvement Act; The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) under section 17 of the Child Nutrition Act of 1966; The Commodity Supplemental Food Program under section 4(a) of the Agriculture and Consumer Protection Act of 1973;

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Page 2 of 3 (f) A state perinatal program (defined for this purpose as a physician, nurse practitioner, certified nurse midwife, family planning clinic, outpatient hospital, or other clinic that provides prenatal medical care or family planning services to Wisconsin Medicaid members);

An Indian Health Service or a health program or facility if it is operated by a tribe or tribal organization under the Indian Self-Determination Act (Public Law 93-638). Application To be qualified to temporarily enroll pregnant women in BadgerCare Plus, interested entities must complete the Application to Become a Certified Provider for BadgerCare Plus Express Enrollment for Pregnant Women form, F-10177. The Security Administrator is any individual the provider designates as the authorized representative to establish online access for the provider. Applicants must complete all fields, except as follows: · The name of the individual completing the form is not required if it is the same as the Security Administrator. · The additional site information is not required if the primary site is the only location. Note: Providers should use a group billing/provider number, whenever possible. Separate applications are not required for satellite locations nor individual providers within a clinic. Notification The Department will notify applicants of approvals or denials in writing. Once your application is approved, we will send you two letters: · The first will be your approval letter which will provide you with a partner/provider number that identifies you as qualified to use the Express Enrollment tool to temporarily enroll pregnant women in BadgerCare Plus. · Your Security Officer will receive an e-mail that will include a one-time use PIN. Once your Security Officer receives the PIN, he or she will be able to log in and set up administrative rights for individuals in your agency to begin using the BadgerCare Plus Express Enrollment application on the ACCESS for Partners and Providers Web site. You will also receive information about where to find instructional materials and information you will need to begin using BadgerCare Plus Express Enrollment.

(g)

Page 3 of 3 Providers may not temporarily enroll pregnant women in BadgerCare Plus without written approval from the Department. Note: Qualified providers may not temporarily enroll anyone in BadgerCare Plus on or after the day their certification as a BadgerCare Plus or Medicaid provider ends. Please call Provider Services at (800) 947-9627 if: · You have questions about the enclosed materials or · Your application is approved, but you do not receive your PIN within seven days following the receipt of your first letter containing your partner/provider number. F-11317 (10/08)