AODA Behavioral Health Credentialing
AODA and Behavioral Health Practitioners
All NEW AODA and BEHAVIORAL HEALTH PRACTITIONERS providing services through the Wraparound Milwaukee Provider Network are required to comply with the credentialing requirements referred to on this page.
COMPLETED Wraparound Milwaukee specific Universal Applications are to be submitted upon request following the agency site visit.
EXISTING PROVIDERS - NEW PRACTITIONERS
COMPLETED Wraparound Milwaukee specific Universal Applications are to be submitted along with the Add Direct Service Provider form.
Questions about the status of a practitioner's application to become a provider in the Wraparound Milwaukee Network should be directed to Theresa Randall at 414-257-8108.
CLICK HERE TO ACCESS THE PROVIDER SPECIALTIY INFORMATION FORM
CLINICIANS CAN USE THIS FORM TO UPDATE SPECIALITY INFORMATION RELATED TO THEIR PRACTICE
SUBMIT UNIVERSAL APPLICATONS AND CHILDREN'S
COMMUNITY HEALTH PLAN OPTION FORMS TO THE
WRAPAROUND MILWAUKEE PROVIDER NETWORK
9201 WATERTOWNK PLANK ROAD
ATTN: THERESA RANDALL
PHONE: 414-257-8108 FAX: 414-257-7575
CHILDREN'S COMMUNITY HEALTH PLAN
Wraparound Milwaukee's role is limited to Credentialing of AODA and Behavioral Health Providers for CCHP.
CCHP "Options Form"
Practitions providing services through the Wraparound Milwaukee Network are asked to identify their intentions to provide services to CCHP enrollees - by completing the CCHP "Options Form".
Practions interested in providing servcies to CCHP enrollee should select the "OPT IN" option on the form.
"DO NOT wish to OPT IN"
Practitioners who are not intersted in becoming a provider for CCHP enrollees, should select the "DO NOT wish to OPT IN" option on the form.
Click here to download CCHP "Options Form". Return completed forms to Wraparound Milwaukee.
ALREADY A PROVIDER FOR CCHP
Practitioners already providing services for the CCHP Network
must complete the Credentialing process in order to
CONTINUE to provide services for Wraparound Milwaukee enrollees
CLICK HERE FOR LINK TO CCHP PROVIDER WEB PAGE
CREDENTIALING INFORMATION AND FORMS
Wraparound Milwaukee Credential Instructions and Forms
Credential process includes
- submitting original copy of signed and dated Universal Application form to Wraparound Milwaukee Provider Network
- verification of practitioner education, training, licensing and certifications
- completion of Background Information Disclosure form
- confirmation of professional liability insurance
- review of practitioner claims history
- Medicaid/Medicare sanctions search
Re-credentialing will occur every 3 years
No individual will be excluded from participating in Wraparound Milwaukee's credentialing process on the basis of gender, race, religion, age, disability, sexual orientation, ethnic origin or client population served
Submit Completed Universal Application Form and CCHP Option forms to:
Wraparound Milwaukee Provider Network
Attn: Theresa Randall
9201 Watertown Plank Road - FAX 414-257-7575 - Phone 414-257-8108