Wisconsin medicaid hospice 2026

1. Click ‘Get Form’ to open the Wisconsin Medicaid Notification of Hospice Benefit Election in the editor.
2. Begin with Section I, which is mandatory for all hospice members. Fill in the member's full name, Member ID, and the date the election form was signed. Ensure accuracy as this information is crucial for processing.
3. Next, provide details about the hospice, including its name and National Provider Identifier (NPI), along with the attending physician's name and NPI. Indicate whether the attending physician is employed by the hospice by selecting 'Yes' or 'No'.
4. If applicable, complete Section II for members residing in a nursing home at the time of hospice election. Include the nursing home's name and NPI, ensuring that both parties agree on service provisions.
5. For members entering a nursing home after hospice admission, fill out Section III with similar details about the nursing home and date of admission.
6. If revoking hospice benefits, complete Section IV by providing necessary details such as Member ID and date signed on the revocation form.
7. Once all sections are completed accurately, save your document and follow instructions to mail it to ForwardHealth.

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