WI Care Wisconsin Provider Update Form free printable template

Confidential1617 Sherman Ave. Madison, WI 53704 (800) 9630035 Fax: (608) 2453844 www.carewisc.orgProvider Update Form Please note this is not a credentialing application. If credentialing is required

How to fill out updated contact or address

How to fill out WI Care Wisconsin Provider Update Form

1. Obtain the WI Care Wisconsin Provider Update Form from the official website or your local health department.
2. Fill in your personal and provider information accurately, including your name, address, and provider ID.
3. Update any changes in your practice information, such as new services offered or changes to your contact information.
4. Review the form for accuracy and completeness.
5. Sign and date the form at the designated space.
6. Submit the completed form either by mail or electronically, as instructed on the form.

Who needs WI Care Wisconsin Provider Update Form?

1. Current healthcare providers who are enrolled in the WI Care program.
2. Providers who have updated their practice information that needs to be reflected in the WI Care system.
3. New providers looking to enroll in WI Care and begin providing services.

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What is WI Care Wisconsin Provider Update Form?

The WI Care Wisconsin Provider Update Form is a document used by healthcare providers in Wisconsin to report changes or updates to their information, ensuring that the state's health care databases remain current and accurate.

Who is required to file WI Care Wisconsin Provider Update Form?

All healthcare providers enrolled in the Wisconsin Medicaid program or those providing services through WI Care are required to file the WI Care Wisconsin Provider Update Form to maintain accurate records.

How to fill out WI Care Wisconsin Provider Update Form?

To fill out the WI Care Wisconsin Provider Update Form, providers should complete the form with their updated information, including provider details, service locations, and any changes in their practice or ownership. It is important to follow the instructions provided with the form meticulously.

What is the purpose of WI Care Wisconsin Provider Update Form?

The purpose of the WI Care Wisconsin Provider Update Form is to facilitate the accurate and timely updating of healthcare provider information in the state’s health care system, which helps in ensuring efficient service delivery and compliance with regulations.

What information must be reported on WI Care Wisconsin Provider Update Form?

The WI Care Wisconsin Provider Update Form must report various information, including the provider's name, address, contact information, National Provider Identifier (NPI), and details regarding services provided or changes in practice status.