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DEPARTMENT OF HEALTH SERVICES Division of Health Care Access and Accountability F-01011 (10/08) STATE OF WISCONSIN DHS 107.31(2)(b), Wis. Admin. Code WISCONSIN MEDICAID PHYSICIAN CERTIFICATION / RECERTIFICATION

How to fill out wisconsin medicaid physician certification

How to fill out Wisconsin Medicaid physician certification:

1. Obtain the form: The Wisconsin Medicaid physician certification form can be found on the official website of the Wisconsin Department of Health Services or through their local offices.
2. Read the instructions: Before filling out the form, carefully read through the instructions provided. This will help ensure that you understand the requirements and provide accurate information.
3. Provide personal details: Start by filling out your personal information such as your name, address, contact information, and any other required details.
4. Include professional information: Provide your professional details, including your medical license number, specialty, and any other relevant credentials.
5. Describe your practice: Provide details about your medical practice, including the name and address of your clinic or hospital, and the types of services you offer.
6. Specify Medicaid participation: Indicate whether you currently participate in the Wisconsin Medicaid program and provide any associated identification numbers.
7. Sign and date the form: After completing all the required information, sign and date the certification form to attest that the information provided is accurate to the best of your knowledge.

Who needs Wisconsin Medicaid physician certification:

1. Medical practitioners: Physicians, including specialists and primary care doctors, who wish to provide medical services to eligible individuals under the Wisconsin Medicaid program need to obtain the physician certification.
2. Medicaid-enrolled patients: Patients who are eligible for Wisconsin Medicaid and wish to receive medical services from a physician are required to seek treatment from a physician who has the necessary Medicaid physician certification.
3. Healthcare facilities: Hospitals, clinics, and other healthcare facilities that participate in the Wisconsin Medicaid program may require physicians working within their organization to have the appropriate certification to ensure compliance with program regulations.

It is important to note that the specific requirements for obtaining and maintaining Wisconsin Medicaid physician certification may vary and it is advisable to consult the official guidelines or contact the Wisconsin Department of Health Services for more detailed information.

For pdfFiller’s FAQs

What is wisconsin medicaid physician certification?

Wisconsin Medicaid physician certification is a process in which physicians verify their eligibility to participate in the state's Medicaid program.

Who is required to file wisconsin medicaid physician certification?

All physicians who wish to participate in Wisconsin's Medicaid program are required to file physician certification.

How to fill out wisconsin medicaid physician certification?

Physicians can fill out the Wisconsin Medicaid physician certification forms online or by mail, providing the required information and documentation.

What is the purpose of wisconsin medicaid physician certification?

The purpose of Wisconsin Medicaid physician certification is to ensure that only eligible and qualified physicians participate in the state's Medicaid program, providing quality healthcare to Medicaid beneficiaries.

What information must be reported on wisconsin medicaid physician certification?

Physicians must report their personal information, medical credentials, practice location, and other relevant details on Wisconsin Medicaid physician certification forms.

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