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Forms LibraryWisconsin Department of Health ServicesMedicaiddhcf - Washington, D CForms LibraryWisco

Forms LibraryWisconsin Department of Health ServicesMedicaiddhcf - Washington, D CForms LibraryWisco 2026

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The document is an application form for Medicaid Certified Personal Care Providers in Wisconsin to gain access to the web-based Personal Care Screening Tool. It outlines the necessary information required from providers and their contract agencies, including contact details and whether they will perform personal care screens directly or through contracted agencies. The completion of the form is voluntary but may delay access if not submitted.

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Click ‘Get Form’ to open it in the editor.
Begin by entering the 'Name – Medicaid Certified Provider' and 'Medicaid Provider Number' in the designated fields.
Fill in your contact details, including 'Name – Contact', 'Telephone Number', and 'Email Address'.
Indicate whether the Medicaid Certified Provider will be performing Personal Care Screens directly by selecting 'Yes' or 'No'.
Answer if the provider is already established for relevant screens by selecting 'Yes' or 'No'.
If contract agencies will conduct Personal Care Screens, select 'Yes' and provide their information in the fields provided.
List each agency's name, contact person, telephone number, and email address as required.
Finally, submit your application by sending it to the specified contact via email or fax.

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Versions	Form popularity	Fillable & printable
2017	4.8 Satisfied (32 Votes)
2010	4 Satisfied (38 Votes)

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What is the email format for the Wisconsin Department of Health Services?

The most common Wisconsin Department of Health Services email format is [first]. [last] (ex. jane.doe@dhs.wisconsin.gov), which is being used by 99.4% of Wisconsin Department of Health Services work email addresses. Other common Wisconsin Department of Health Services email patterns are [last][firstinitial] (ex.

Is BadgerCare the same as Medicaid in Wisconsin?

No. 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.

How do I contact Wisconsin Medicaid?

Call Member Services at 800-362-3002 or email them at memberservices@wisconsin.gov Theyre available from 8 a.m.6 p.m. Monday through Friday.

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How do I talk to a human at Medicaid?

California California State Contacts. Eligibility. Enrollment. ☎ Call the Medi-Cal Helpline: 800-541-5555, or 916-636-1980.

What does the Wisconsin Department of Health Services do?

Its responsibilities include public health; mental health and substance abuse; long-term support and care; services to people with disabilities, medical assistance, and childrens services; aging programs; physical and developmental disability services; blindness disability programs; operation of care and treatment

How do I contact Medicaid in Wisconsin?

All applicants and members Call Member Services at 800-362-3002 or email them at memberservices@wisconsin.gov Theyre available from 8 a.m.6 p.m. Monday through Friday. They can help you: Find a provider. Get a new ForwardHealth card.

Forms LibraryWisconsin Department of Health ServicesMedicaiddhcf - Washington, D CForms LibraryWisco 2026

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How do I sign my Forms LibraryWisconsin Department of Health ServicesMedicaiddhcf - Washington, D CForms LibraryWisco online?

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What is the email format for the Wisconsin Department of Health Services?

Is BadgerCare the same as Medicaid in Wisconsin?

How do I contact Wisconsin Medicaid?

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How do I talk to a human at Medicaid?

What does the Wisconsin Department of Health Services do?

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Forms LibraryWisconsin Department of Health ServicesMedicaiddhcf - Washington, D CForms LibraryWisco 2026

Here's how it works

How to use or fill out Forms Library Wisconsin Department of Health Services Medicaid with our platform

See more Forms LibraryWisconsin Department of Health ServicesMedicaiddhcf - Washington, D CForms LibraryWisco versions

Complete this form in 5 minutes or less

Got questions?

How do I sign my Forms LibraryWisconsin Department of Health ServicesMedicaiddhcf - Washington, D CForms LibraryWisco online?

How do you edit Forms LibraryWisconsin Department of Health ServicesMedicaiddhcf - Washington, D CForms LibraryWisco on iOS?

What is the email format for the Wisconsin Department of Health Services?

Is BadgerCare the same as Medicaid in Wisconsin?

How do I contact Wisconsin Medicaid?

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People also ask

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