Get Wi Wps Health Insurance Facility Data Sheet 2021-2026

Filling out the WI WPS Health Insurance Facility Data Sheet online is an essential process for notifying WPS Health Plan of any changes, additions, or terminations to facilities within your organization. This guide will walk you through each section and field to ensure accurate and efficient completion.

Follow the steps to complete your facility data sheet

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Complete Section 1: Contact Information. Fill in today's date, your name, organization, address (city, state, zip), telephone number, and federal tax ID number.
3. Move to Section 2: Credentialing Contact. Enter the fax number and email address. If it is the same as in Section 1, check the appropriate box. Complete the contact information fields: name, organization, address, telephone number, and fax number.
4. In Section 3: Facility Information, select the appropriate action: add, term, or update facility. For new additions, check ‘ADD FACILITY’ and complete Section A. Include information like location name, facility NPI, county, and effective date.
5. If terminating a facility, check ‘TERM FACILITY’ and complete Section B by adding the facility name, address, and termination date.
6. For updates, check ‘UPDATE FACILITY’ in Section C and provide details of the changes including the previous information and effective date.
7. Once all information is completed in the required sections, review everything for accuracy. Users can then save changes, download, print, or share the form as needed.

Start filling out your WI WPS Health Insurance Facility Data Sheet online today.