Provider Network

SFCA is committed to ensuring that our provider network is adequate to meet the needs of our members. We are equally committed to ensuring that our providers demonstrate competency and quality in the provision of service to our members. SFCA Provider Network Development staff will handle and process all requests to add providers to the Provider Network and all requests for Out of Network Providers. Care Managers will help members/guardians through the process of requesting a specific provider. Providers are also able to request a contract with SFCA by contacting the Provider Network Development staff directly. Upon receiving such request, the Provider Network development staff may send a provider application package to the provider requesting a contract.

• Provider Resources • Forms        • Provider Network Staff • SFCA Provider Bulletins      February 26, 2010        December 7, 2009        October 19, 2009       September 10, 2009       July 1, 2009

Provider Resources

SFCA Provider Handbook

The SFCA Provider Handbook provides information regarding members, authorization and services.

Interpreters and Translators

SFCA members receive equal access to services, regardless of physical or communication limitations. (See our Access Policy.) Providers who are unable to provide full physical access to members because of structural issues are still responsible for needed spoken or sign language interpreters for their residents. See the Wisconsin Department of Health Services website for an Interpreter Directory and a list of Wisconsin Interpreter Referral Agencies.

Family Care and Medicaid Information

A list of items covered in the Family Care Benefit Package is available at dhs.wisconsin.gov/ltcare/Generalinfo/Benpackage.htm. See Addendum IX, pages 195-205, of the 2008 Health and Community Supports Contract (PDF, 597 KB) for complete definitions of Family Care Benefit services.

If you have general questions about Medicaid/BadgerCare billing and covered services, you can call Wisconsin Medicaid Provider Services at at 800-947-9627 or 608-221-9883.

Forms

Unintended Events Form

Billing and Information Forms

WPS Claim Form     Tips for completing the WPS Claim Form

Taxpayer Identification Request (W-9)
You can fill this form out on your computer, and then print and mail or fax it to us. Adult Family Home and CBRF providers must also complete the Adult Family Home/CBRF Additional Tax Information Form.

Provider Information Form
Use this form to provide us with updated contact information.

Provider Application and Contract

SFCA Provider Application     SFCA Provider Authorization and Release

1-2 Bed Adult Family Home Insurance Attestation Form

Supportive Home Care Provider Application Checklist

Please email provider_network@familycarealliance.org to request a copy of our contract template.

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