Medicine and Surgery Section - Wisconsin.gov

General Information
Treatment (EPSDT) (see 42 CFR Parts
441.56 - 441.62). HealthCheck consists of a
comprehensive health screening of Wisconsin
Medicaid recipients under age 21. The
screening includes review of growth and
development, identification of potential physical
or developmental problems, preventive health
education, and referral assistance to
appropriate providers.
Physicians who are Wisconsin Medicaid
certified with a specialty of family practice,
general practice, internal medicine, or
pediatrics and nurse practitioners with
specialties of certified pediatric nurse
practitioner and certified family nurse
practitioner are automatically certified as
HealthCheck screeners at the time of initial
Medicaid certification and recertification.
Providers (physicians and nurse practitioners
with other specialties and physician assistants)
who are interested in becoming HealthCheck
screeners may refer to the Medicaid Web site
or call Provider Services.
Presumptive Eligibility for
Pregnant Women Benefit
Physicians, physician assistants, nurse
practitioners, and nurse midwives may become
Medicaid-certified presumptive eligibility (PE)
providers. Presumptive Eligibility for Pregnant
Women Benefit providers determine whether a
pregnant woman may be eligible for Wisconsin
Medicaid. The PE for Pregnant Women
Benefit is a limited benefit category that allows
an uninsured or underinsured (i.e., insured
without prenatal coverage) pregnant woman to
receive immediate pregnancy-related
outpatient services while her application for
full-benefit Medicaid is processed. Refer to the
Guide to Determining Presumptive Eligibility
for Pregnant Women Benefit for more
information.
Providers interested in becoming certified to
make PE for pregnant women determinations
may refer to the Medicaid Web site or call
Provider Services.
Presumptive Eligibility for the
Family Planning Waiver Program
Providers qualified to make PE decisions for
pregnant women may also make PE decisions
for women to receive routine contraceptiverelated
services and supplies immediately
through PE for the Family Planning Waiver
Program (FPWP) for up to three months.
Services and supplies covered under PE for
the FPWP are the same as those covered
under the FPWP and must be clearly related to
routine contraceptive management.
Refer to the Provider section of the Medicaid
Web site for more information about the
FPWP. Providers interested in becoming
certified to make PE for the FPWP
determinations may refer to the Medicaid Web
site or call Provider Services.
Prenatal Care Coordination
Certification
Prenatal care coordination (PNCC) services
help pregnant women who are identified as
being at high risk for negative birth outcomes
gain access to, coordinate, and follow up on
necessary medical, social, educational, and
other services. Providers interested in
becoming PNCC providers may refer to the
Medicaid Web site or call Provider Services.
Durable Medical Equipment
To be reimbursed for dispensing durable
medical equipment, physicians are required to
obtain separate Medicaid certification as a
medical equipment vendor. Physicians are
required to comply with all federal laws and
regulations, including the Stark statute on
referrals. Providers interested in becoming
Medicaid-certified medical equipment vendors
may refer to the Medicaid Web site or call
Provider Services.
Provider Numbers
Wisconsin Medicaid issues billing performing,
group, and nonbilling performing provider
numbers to physician services providers. Refer
to the Certification and Ongoing
10 Wisconsin Medicaid and BadgerCare dhfs.wisconsin.gov/medicaid/ December 2005
Wisconsin
Medicaid issues
billing performing,
group, and
nonbilling
performing
provider numbers
to physician
services providers.