Wis. ForwardHealth Online Handbook, Hospice, Topic #216

Responsibilities for which providers are held accountable are described throughout the Online Handbook. Medicaid-enrolled

providers have responsibilities that include, but are not limited to, the following:

• Providing the same level and quality of care to ForwardHealth members as private-pay patients

• Complying with all state and federal laws related to ForwardHealth

• Obtaining PA (prior authorization) for services, when required

• Notifying members in advance if a service is not covered by ForwardHealth and the provider intends to collect payment

from the member for the service

• Maintaining accurate medical and billing records

• Retaining preparation, maintenance, medical, and financial records, along with other documentation, for a period of not less

than five years from the date of payment, except rural health clinic providers who are required to retain records for a

minimum of six years from the date of payment

• Billing only for services that were actually provided

• Allowing a member access to their records

• Monitoring contracted staff

• Accepting Medicaid reimbursement as payment in full for covered services

• Keeping provider information (for example, address, business name) current

• Notifying ForwardHealth of changes in ownership

• Responding to Medicaid revalidation notifications

• Safeguarding member confidentiality

• Verifying member enrollment

• Keeping up-to-date with changes in program requirements as announced in ForwardHealth publications