Wis. ForwardHealth Online Handbook, Hospice, Topic #3969

Wisconsin Medicaid enrolls providers in three billing categories. Each billing category has specific designated uses and restrictions.

These categories include:

• Billing and rendering provider

• Rendering-only provider

• Billing-only provider (including group billing)

Providers should refer to the service-specific information in the Online Handbook or the Information for Specific Provider Types

page on the Provider Enrollment Information home page to identify which category of enrollment is applicable.

Billing and Rendering Provider

Enrollment as a billing and rendering provider allows providers to identify themselves on claims (and other forms) as either the

provider billing for the services or the provider rendering the services.

Rendering-Only Provider

A provider enrolled as a rendering-only provider who practices under the professional supervision of another provider.

Rendering-only providers enrollment cannot submit claims to ForwardHealth directly. Instead, they have reimbursement rates

established for their provider type. Claims for services provided by a rendering provider must include the supervising provider or

group provider as the billing provider.

Billing-Only Provider (Including Group Billing)

Billing-only providers can submit claims to ForwardHealth while a separate rendering-only provider is required on those claims.

Group Billing

Groups of individual practitioners are enrolled as billing-only providers as an accounting convenience. This allows the group to

receive one reimbursement, one RA (Remittance Advice), and the 835 (835 Health Care Claim Payment/Advice) transaction for

covered services rendered by individual practitioners within the group.

Providers may not have more than one group practice enrolled in Wisconsin Medicaid with the same ZIP+4 code address, NPI

(National Provider Identifier), and taxonomy code combination. Provider group practices located at the same ZIP+4 code

address are required to differentiate their enrollment using an NPI or taxonomy code that uniquely identifies each group practice.

Individual practitioners within group practices are required to be Medicaid-enrolled because these groups are required to identify

the provider who rendered the service on claims. Claims indicating these group billing providers that are submitted without a

rendering provider are denied.