MedicaidAdministrativeMedium impact
New Contact Information and Forms for the Pharmacy Services Lock-In Program
Wisconsin Medicaid (ForwardHealth)·WI · Pharmacy·Pharmacy
Effective date
May 17, 2010
We identified it
Jun 20, 2026
Summary
Wisconsin Medicaid has updated contact information and forms for the Pharmacy Services Lock-In Program. New versions of the Member Referral form (F-11183) and Request for Review form (F-00250) are now required, and old forms will be rejected after May 17, 2010.
Action Required
By May 17, 2010: Billing and clinical staff must update to new versions of forms F-11183 (Member Referral) and F-00250 (Request for Review) for Pharmacy Services Lock-In Program. Download new forms from ForwardHealth Portal at www.forwardhealth.wi.gov/. Old form versions will be rejected and cause processing delays.