Application and Credentialing

Are you a provider interested in expanding your reach? Whether your specialty is Primary and Acute Services, Behavioral Health, Long-Term Care (LTC), Durable Medical Equipment (DME), or another specialty, you are encouraged to apply to join the iCare network to provide services for members with Medicare and/or Medicaid coverage.

The combination of high-quality providers and personal care management translates to improved patient outcomes. 

Independent Care Health Plan welcomes a variety of providers to join our Provider Network to assure the broadest choice of quality providers for iCare Members. We are accepting applications for:

Application

Application Instructions: 
All providers are required to complete an application to be considered for participation in iCare's Provider Network. For assistance in determining the correct application, please review the Provider Applications List.

• Behavioral Health Providers: Behavioral Health Provider application.
• Certification for 1-2 bed Adult Family Home (AFH): AFH Certification application.
• Durable Medical Equipment (DME) Providers: DME Provider application.
• Long-Term Care (LTC) Providers: Long-Term Care and Family Care Partnership Services Provider application.
  • iCare is prioritizing Long-Term Care Provider Applications in the following areas:
    • Residential Facilities
      • Non-Ambulatory
      • Behavioral Complexity experience
      • Mental Health-AODA experience
      • Memory Care experience
    • Environmental Accessibility Adaptations (home modifications)
• All other Providers: Primary and Acute Services Provider application.

Do not complete any of the above applications if you are already contracted with iCare and trying to provide updated demographic or affiliation information. Please complete either our Demographic Change Form or our Affiliation Change Form and email to providerupdates@icarehealthplan.org or fax to (414) 272-5618, ATTN: Network Development.

Completed applications (and applicable attachments) may be emailed to providerupdates@icarehealthplan.org or faxed to (414) 272-5618, ATTN: Network Development.

What to Expect

After the complete application has been submitted, notification will be sent by e-mail indicating that the application has been received. Incomplete applications will be returned without further review. The Network Development Team will then review the application against iCare's current Provider Network. If iCare is in need of the services being offered, the applicant will be contacted by a Network Development Contract Specialist. If iCare is not expanding the Provider Network for the submitted service area and/or category indicated on the application, a letter will be sent informing the applicant of the decision. An application denial does not restrict a provider from applying again in the future.

*Please note that submission of any Provider Application does not confirm your network participation status with iCare. Participation in the iCare Provider Network requires completion of credentialing and execution of a Service Agreement. Providers will be notified in writing after the contract is fully executed.

Credentialing

Independent Care Health Plan only credentials provider organizations and their affiliated practitioners, after the Network Development Team has reviewed the Provider Application and decided to move forward with the contracting process. iCare's Credentialing Department will review your application and may also contact you with additional information requests or questions.

If your organization has practitioners that require credentialing or if you are an individual solo-practice, an application and return envelope will be mailed to you from Rural Wisconsin Health Cooperative, iCare's contracted credentials verification organization.

Minimum Individual Provider Credentialing Criteria

1. A current valid, unrestricted Wisconsin license or certification if licensure is not available
2. Wisconsin Medicaid certification
3. Medicare Certification (if applicable)
4. Current professional liability insurance adequately meeting minimum state requirements as defined by State of Wisconsin Statute and Administrative Code relating to practice of Medicine (See Wis. Stats. §655.23)
5. Completed appropriate education and training for applied specialty
6. Acceptable malpractice liability claims history
7. Sanction-free status by federal and state regulatory authorities
8. Lack of physical or mental impairment, including chemical dependency, that may impair the provider's ability to practice or may pose a risk of harm to patients
9. Current Attestation and Authorization for Release of Information

Additional Criteria For Physicians:

1. A current valid unrestricted Drug Enforcement Administration (DEA) certificate, if applicable to profession
2. Current unrestricted admitting privileges at an iCare participating hospital. If privileges are not present the Credentials Review Committee may consider a waiver following review of coverage arrangements. Provider must give written evidence of coverage by a participating iCare provider or facility
3. Evidence of 24 hours per day, 7 day per week professional coverage arrangements