How to become a Medicaid provider in Wisconsin
To bill Wisconsin Medicaid, enroll through ForwardHealth Portal — Become a Provider / Provider Enrollment Information, run by Gainwell Technologies. The process has 6 steps, listed below with the documents the state asks for.
- Enrollment portal
- ForwardHealth Portal — Become a Provider / Provider Enrollment Information
- Steps
- 6
- Documents
- 5
- Plans listed
- 13
On this page
Wisconsin Medicaid enrollment at a glance
To bill Wisconsin Medicaid, enroll through ForwardHealth Portal — Become a Provider / Provider Enrollment Information, run by Gainwell Technologies. The process has 6 steps, listed below with the documents the state asks for.
- Program
- Wisconsin Medicaid / BadgerCare Plus (ForwardHealth, Wisconsin Department of Health Services)
- Fiscal agent
- Gainwell Technologies (supports ForwardHealth interChange as the state's fiscal agent)
- Application fee
- ForwardHealth's handbook says some provider types owe the federally mandated application fee, which can change each year and offsets screening costs. It may be due again at re-enrollment and, where applicable, at revalidation. Under the federal rule (42 CFR 455.460), institutional providers pay the CMS application fee when they first enroll, re-enroll or revalidate. The fee is $750 for calendar year 2026. Individual physicians and non-physician practitioners do not pay it. A fee already paid to Medicare or to another state's Medicaid program counts.
- Fingerprinting
- ForwardHealth assigns limited, moderate or high risk, mostly using CMS's levels, and screens at enrollment, re-enrollment and revalidation. Under federal rules (42 CFR 455.434 and 455.450), the state places provider types in 'limited', 'moderate' or 'high' risk levels. High-risk providers, and anyone who owns 5% or more of one, must submit fingerprints for a criminal background check.
- Site visit
- Screening follows the assigned risk level at enrollment, re-enrollment and revalidation. For some provider types, such as supportive housing agencies, the DHS Office of Inspector General does a site visit before revalidation can be completed. Under federal rule (42 CFR 455.432), the state must visit moderate- and high-risk providers before and after enrollment. Every enrolled provider must allow unannounced on-site inspections.
- Revalidation
- Wisconsin revalidates every enrolled provider every three years, more often than the federal 5-year minimum. ForwardHealth mails a Provider Revalidation Notice giving the revalidation date (also visible via 'Check My Revalidation Date' on the secure Portal). Revalidation cannot start before that date, and the application, plus any fee, is due within 30 days after it. Providers who miss the deadline are terminated and must re-enroll with new screening and possibly another fee. During revalidation the provider re-signs the Provider Agreement and Acknowledgement of Terms of Participation.
- Provider manual
- Provider manual
Steps
- Check the Provider Enrollment Information pages and the Online Handbook for your provider type's enrollment criteria and category (billing and rendering, rendering-only, or billing-only)
- Get an NPI and fill out the online enrollment application on the ForwardHealth Portal
- Pay the application fee if your provider type owes it, and complete risk-based screening
- Electronically sign the Wisconsin Medicaid Provider Agreement and Acknowledgement of Terms of Participation
- Track the application with Enrollment Tracking Search
- To serve BadgerCare Plus or SSI HMO members, contract with each HMO
Documents the state asks for
Joining managed-care plan networks
- Credentialing
- BadgerCare Plus and Medicaid SSI members are mostly served by state-contracted HMOs; long-term care runs through Family Care MCOs. Providers enroll with Wisconsin Medicaid through ForwardHealth and contract with each HMO separately. DHS pages reviewed describe no centralized credentialing. DHS requires every BadgerCare Plus HMO to hold NCQA Health Plan and Health Outcomes accreditation.
- Plans (state list)
- Anthem Blue Cross and Blue Shield
- Chorus Community Health Plans
- Dean Health Plan
- Group Health Cooperative of Eau Claire
- Group Health Cooperative of South Central Wisconsin
- Independent Care Health Plan (iCare)
- MercyCare Insurance Company
- MHS Health Wisconsin
- Molina Health Care
- Network Health Plan
- Quartz
- Security Health Plan of Wisconsin
- United Healthcare Community Plan (UHC)
Frequently asked questions
How do I become a Medicaid provider in Wisconsin?
To bill Wisconsin Medicaid, enroll through ForwardHealth Portal — Become a Provider / Provider Enrollment Information, run by Gainwell Technologies. The process has 6 steps, listed below with the documents the state asks for.
Is there an application fee to enroll in Wisconsin Medicaid?
ForwardHealth's handbook says some provider types owe the federally mandated application fee, which can change each year and offsets screening costs. It may be due again at re-enrollment and, where applicable, at revalidation. Under the federal rule (42 CFR 455.460), institutional providers pay the CMS application fee when they first enroll, re-enroll or revalidate. The fee is $750 for calendar year 2026. Individual physicians and non-physician practitioners do not pay it. A fee already paid to Medicare or to another state's Medicaid program counts.
How often must Wisconsin Medicaid providers revalidate?
Wisconsin revalidates every enrolled provider every three years, more often than the federal 5-year minimum. ForwardHealth mails a Provider Revalidation Notice giving the revalidation date (also visible via 'Check My Revalidation Date' on the secure Portal). Revalidation cannot start before that date, and the application, plus any fee, is due within 30 days after it. Providers who miss the deadline are terminated and must re-enroll with new screening and possibly another fee. During revalidation the provider re-signs the Provider Agreement and Acknowledgement of Terms of Participation.