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DEPARTMENT OF HEALTH SERVICES Division of Medicaid Services F11304 (04/2022)STATE OF WISCONSIN Wis. Admin. Code DHS 107.10(2)FORWARDHEALTHPRIOR AUTHORIZATION DRUG ATTACHMENT FOR CYTOKINE AND CELL
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Healthcare providers who are in the field of substance abuse treatment and prevention may need to fill out ForwardHealth Provider Type 24.
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ForwardHealth provider type 24 is a designation for healthcare providers who offer specific services under Wisconsin's Medicaid program.
Providers offering certain services under Wisconsin's Medicaid program are required to file ForwardHealth provider type 24.
ForwardHealth provider type 24 can be filled out online through the Wisconsin Medicaid portal or by submitting a paper form with all the required information.
The purpose of ForwardHealth provider type 24 is to ensure that healthcare providers offering specific services are properly identified and recognized under Wisconsin's Medicaid program.
Information such as provider name, address, type of service provided, and NPI number must be reported on ForwardHealth provider type 24.
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