MedicaidAdministrativeHigh impact
For Prenatal Care Coordination Providers: Milwaukee County Transition and Statewide Changes to Memoranda of Understanding Requirement
Wisconsin Medicaid (ForwardHealth)·WI · OB-GYN, Family Medicine, General Practice·Medical Policy
Effective date
Jan 1, 2027
We identified it
Sep 29, 2026
Summary
Beginning January 1, 2027, prenatal care coordination (PNCC) services for Medicaid members enrolled in Milwaukee County will be reimbursed directly by Wisconsin Medicaid HMOs and Partnership MCOs instead of through ForwardHealth fee-for-service. PNCC providers must enroll with Wisconsin Medicaid and contract individually with each HMO/MCO in the service area. Additionally, memoranda of understanding (MOU) requirements for PNCC providers have been eliminated statewide (effective October 1, 2025).
Action Required
IMMEDIATE ACTIONS (Now - December 31, 2026): Billing team must identify all PNCC patients in Milwaukee County currently enrolled in Wisconsin Medicaid HMOs or Partnership MCOs. Continue billing these services to ForwardHealth as fee-for-service through December 31, 2026. BEFORE JANUARY 1, 2027: (1) Providers must enroll with Wisconsin Medicaid as PNCC providers via the ForwardHealth Portal Provider Enrollment Information page if not already enrolled. (2) Billing and contracting teams must contact each Wisconsin Medicaid HMO and Partnership MCO in Milwaukee County individually to initiate contracting and credentialing processes—allow several months for completion. (3) Obtain each HMO/MCO's specific billing requirements, claim submission timelines, coding standards, and documentation requirements. (4) Update billing system workflows to route Milwaukee County Medicaid HMO/MCO patient claims to the appropriate managed care entity instead of ForwardHealth. (5) Register for and attend the ForwardHealth online information session on April 23, 2026 (10–11:15 a.m.). CONSEQUENCE OF INACTION: Claims for Milwaukee County Medicaid HMO/MCO members submitted to ForwardHealth after December 31, 2026 will be denied; providers must bill HMOs/MCOs directly to receive reimbursement. Resource: Request the Prenatal Care Coordination Provider Resource flyer (P-03778) for HMO/MCO contact information.