Some healthcare providers have experienced a technical disruption. If you cannot get care or communication about that care, please reach out to us via Member Services.
Medicaid SSI and BadgerCare Plus services now offered by Molina Healthcare
Are you current on your vaccinations? Check with your primary caregiver or team.
You deserve the best! Please reply to the 2024 Satisfaction Survey if you're a Family Care or Partnership member or guardian who has received the survey!
The Annual Enrollment Period is now open! Call 800-963-0035 to speak with a Medicare Advisor
The Flu Season is upon us. Have you received your flu shot? Call your Care Team for assistance.
ALERT: Effective July 1, 2024, My Choice Medicaid SSI and BadgerCare Plus has transitioned to Molina Healthcare of Wisconsin. View Molina’s Medicaid provider page here.
Effective January 1, 2025, the Molina and My Choice Wisconsin Medicare products will be combined. The combined Medicare Dual Advantage product will be administered through legacy My Choice Wisconsin channels and platforms. View the latest updates here.
Provider Questions? We've got answers!
We value your time and want you to be able to find answers quickly. We’ve compiled commonly asked provider questions below.
Points of Contact
Family Care, Partnership, and Dual Advantage Providers Contract Services Assistant Phone: 414-287-7640 Toll Free: 877-489-3814 [email protected]
Care Management Please contact the assigned Care Manager
My Choice Wisconsin Customer Service Toll Free: 1-800-963-0035
Provider Q&A
• My Choice Wisconsin offers all long-term care and acute and primary care services in support of the Family Care, Partnership, Medicare Dual Advantage HMO SNP.
Call 800-963-0035 and staff will be happy to assist.
For detailed information on the claims process, please see our Claims page. Please contact the appropriate TPA with claims questions:
Partnership, Dual Advantage, and legacy Care Wisconsin Family Care member claims are processed by Cognizant (Trizetto): 1-855-878-6699.
All other Family Care claims are processed by WPS: 1-800-223-6016.
For detailed information on the authorizations process, please see the Authorizations page.
Family Care members – authorization is required prior to rendering ALL services for Family Care. You must contact the member’s care team to get an authorization; providers will be able to see and/or print the authorization from the MIDAS portal.
Partnership, and Medicare Dual Advantage Members – please use the My Choice Wisconsin form appropriate for the service and fax to (608) 210-4050.
Authorizations do not display in MIDAS until 5 days before the start date of the authorized service.
No, you can submit your claims the way you always have. The use of MIDAS for claims submission is not required.
All claims submitted through the MIDAS portal are in process. Because this is a new process for legacy Care Wisconsin providers, there will be a short delay in payment. Do not resubmit the claims or you will delay your payment further due to duplicate claims in the system.
The MIDAS system displays either the MIDAS Member ID or (if printed) the member’s SSN. These numbers should NOT be used for claim submission. You should use the Care Wisconsin Member ID or the member’s Medicaid ID. Please know My Choice Wisconsin is working to remove all member SSNs from printing and distribution.
Rates are negotiated between each individual provider and our managed care organization. Because the MCO receives varied capitation rates between counties served, not all rates will be the same.
There are many factors that go into the contracting process. The credentialing and rate negotiation process varies depending on the provider type, size, number of employees, number of locations, and responsiveness to requests for additional information. Generally, the process for contracting takes from 60 to 90 days.
My Choice Wisconsin needs to determine whether Medicare is the primary insurer. There is extensive documentation and requirements that must be met in order to satisfy Medicare approval prior to the receipt of DME products. Because Family Care is a secondary payor source, the primary payor must be established first.
Providers are required to update their bed availability and contact information in the MIDAS Portal prior to submitting claims for billing. Keeping bed availability updated will allow the Residential Team visibility to your bed openings so they can be filled more quickly. When you are listed as having an opening, a member of the care team or residential team will reach out to you via phone or email with appropriate referrals.
Please reference the tutorial for updating bed availability at: MIDAS>User Documents>Provider Portal>Provider Resources>Provider Tutorials> MIDAS Bed Information Tutorial.pdf
When a member needs placement, our residential team works closely with the member’s care team to ensure viable placement options are available for consideration. There are several factors that go into placement decisions, including the member’s ability to afford the room and board at the in-network residential facility of their choice, the provider’s ability to meet the individual member’s needs, and the proximity of placement. Placement is a collaborative process between the member, care team, and guardian, as applicable.
Providers interested in certification through My Choice Wisconsin should reach out to the Contracts and Provider Relations Department (414-287-7640) to determine if and what types of AFH applications are being accepted. If applications are being accepted, please submit a provider application. After an initial screening, the provider will be referred to an AFH Certifier to arrange for certification application and a site visit. Certification guidelines can also be viewed on the Wisconsin DHS website. We will accept previous certifications from another MCO.
As of November 2, 2020, the Wisconsin Department of Health Services (DHS) begins implementing Electronic Visit Verification (EVV) for Medicaid-covered personal care services. Please visit our new EVV webpage or the DHS website for the latest information on EVV including training guides, EVV ForwardHealth Policy, Provider Newsletters, and Podcasts. Contact DHS EVV Customer Care for any questions about EVV Implementation at 833-931-2035 or [email protected].
For any questions for MCW about EVV send an email to [email protected].
My Choice Wisconsin believes in the importance of educating ourselves to provide culturally competent care to those we serve. You may find suggested resources in our Cultural Competency Provider Resources document, which can also be found in the Provider Resource Library.
