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  • Wi F-01153 2022

Get Wi F-01153 2022-2025

DEPARTMENT OF HEALTH SERVICES Division of Health Care Access and Accountability F-1153 02/09 STATE OF WISCONSIN FORWARDHEALTH BREAST PUMP ORDER ForwardHealth requires certain information to enable the programs to authorize and pay for medical services provided to eligible members. Members of ForwardHealth are required to give providers full correct and truthful information for the submission of correct and complete claims for reimbursement. This information should include but is not limited to information concerning enrollment status accurate name address and member identification number DHS 104. 02 4 Wis. Admin* Code. Under s. 49. 45 4 Wis. Stats. personally identifiable information about applicants and members is confidential and is used for purposes directly related to ForwardHealth administration such as determining eligibility of the applicant or processing provider claims for reimbursement. Failure to supply the information requested by the form may result in denial of payment fo....

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Wisconsin's Medicaid provides health care coverage for those who: Are age 65 or older, blind, or disabled. Have family income at or below the monthly program limit. Are U.S. citizens or legal immigrants.

BadgerCare Plus for Families If you are applying for or enrolled in BadgerCare Plus for Families, you may be able to enroll in BadgerCare Plus, even if you have access to an employer health insurance plan.

Department of Health Services1-608-266-1865 1-888-701-1251 (TTY)ForwardHealth Portal Help Desk1-866-908-1363Resources for ProvidersForwardHealth Provider Services1-800-947-9627WiCall Automated Voice Response (AVR) System1-800-947-354414 more rows

To enroll in Wisconsin Medicaid, providers are required to complete the application process. Failure to complete the enrollment application process will cause a delay, and may cause denial, of enrollment. Providers have 10 calendar days to complete an application on the ForwardHealth Portal once they begin it.

BadgerCare Plus is a separate program from Medicaid. It offers similar benefits and also targets low income and disabled residents but has different parameters and eligibility.

If you are interested in applying for Wisconsin Medicaid, please contact your local county or tribal agency or call Member Services at 800-362-3002. This number is for members, member advocates, and those interested in applying for Medicaid.

Contact Information. The help desk can be reached (Toll-free) at 1-866-908-1363 between the hours of 8:30 AM — 4:30 PM Monday through Friday.

ForwardHealth supports BadgerCare Plus HMO and Medicaid SSI HMO enrollee rights regarding the confidentiality of health care records.

Effective February 1, 2023 Family Size100% FPL250% FPL1$1,215.00$3,037.502$1,643.33$4,108.333$2,071.67$5,179.184$2,500.00$6,250.007 more rows • Feb 1, 2023

Key contacts and other telephone numbers. Call Member Services at 800-362-3002 or email memberservices@wisconsin.gov . If you need help applying, contact your agency. If you are a health care provider or HMO representative, contact Provider Services at 800-947-9627.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232