MedicaidAdministrativeHigh impact
Policy Clarification for Services That Are Prescribed, Referred, or Ordered
Wisconsin Medicaid (ForwardHealth)·WI·Medical Policy
Effective date
Jul 15, 2013
We identified it
Jun 20, 2026
Summary
Wisconsin Medicaid now requires the National Provider Identifier (NPI) of the prescribing/referring/ordering provider on all prior authorization requests and claims for prescribed, referred, or ordered services. Claims and prior authorizations will be denied or returned if this information is missing or if the prescribing provider is not Medicaid-enrolled.
Action Required
Immediately for Wisconsin Medicaid claims: Billing team must update all claim submission processes to include the NPI of the prescribing/referring/ordering provider for all prescribed, referred, or ordered services including ambulance, DME, lab, radiology, pharmacy, home health, hospice, and therapy services. Verify all prescribing providers are Medicaid-enrolled or assist them in completing abbreviated enrollment. Update billing software to require this field or claims will be denied. Providers cannot bill members for services denied due to missing prescriber NPI information.