All new and existing AODA and BEHAVIORAL HEALTH PRACTITIONERS providing services through the Wraparound Milwaukee Provider Network are required to comply with the credentialing requirements as indicated. Re-credentialing will occur every 3 years for active, current practitioners in the Network.
NEW VENDORS
Completed Wraparound Milwaukee Universal Application are to be submitted upon request following the agency site visit.
EXISTING VENDORS – NEW PRACTITIONERS
Completed Wraparound Milwaukee Universal Application are to be submitted along with the Add Request Form, to include documentation outlined on the form.
WRAPAROUND MILWAUKEE CREDENTIALING INFORMATION AND FORMS
Credentialing applications must include:
- Original copy Universal Application (completed, signed and dated) form to Wraparound Milwaukee Provider Network
- Verification of practitioner’s education, training, licensing and/or certifications
- Completion of background check (all 3 parts)
- Confirmation of professional liability insurance
- Medicaid/Medicare sanctions search
Related Information/Forms Universal Application
Tips for Completing Credentialing Process Credentialing/Recredentialing Criteria
Primary Source Verification Credentialing/Recredentialing Plan
PROVIDER SPECIALTIY INFORMATION FORM
Submit Completed Universal Application Form to:
Mail: Wraparound Milwaukee Provider Network
9455 Watertown Plank Road, Milwaukee, WI 53226
Email: [email protected]
Fax: 414-257-7575
Questions about the status of a practitioner’s application should be directed to Theresa Randall or Dana James of Wraparound Milwaukee.
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.