Joining Our Provider Network

Lakeland Care will add providers to the network when all of the following standards are met:

• The provider is willing to submit other materials as requested by Lakeland Care to demonstrate rendering of quality service, and competency
• The requested service is in the Family Care benefit package;
• Network capacity indicates a need for additional providers within the applicable service code category (this standard is not applicable to Community Based Residential Facilities (CBRFs), Residential Care Apartment Complexes (RCACs), community rehabilitation programs, home health agencies, day service providers, personal care providers, or nursing facilities);
• The provider agrees to be reimbursed at Lakeland Care’s contracted rate negotiated with similar providers for the same care, services, and/or supplies;
• The provider meets all applicable licensing/certification requirements as they apply to the services to be provided;
• The provider has demonstrated an ability to meet other applicable standards that are required by law or per their contract with Lakeland Care;
• The provider has positive references that demonstrate competency and quality services;
• The provider is willing to adhere to all components of Lakeland Care contract and addendums; and
• The provider is willing to submit other materials as requested by Lakeland Care to demonstrate rendering of quality service, and competency

• If you are interested in becoming a contracted provider with Lakeland Care view the training on Becoming a LCI Service Provider to learn about Lakeland Care and what is required to become a contracted provider.
• To become a provider for Lakeland Care apply online click here.
  • To view our Provider Application guide, please click here.
• A member of the Provider Contracting Team will contact the provider within 3 business days of receipt of the online application. 
• Upon receipt of all completed application documents, agreement of service provisions, and determination/negotiation of rates, a “Service Provider Contract” will be issued to the provider within 5 business days. 

• Lakeland Care Service Provider Application (Residential or Non-Residential)
• Copies of all applicable licensing/certification requirements as they apply to the service that the provider intend to provide.
• Copy of insurance policy(s) and bonding (if applicable).
• Provider Agreement Form
• Background Check Attestation Letter
• Debarment Attestation Letter
• Training Attestation Letter
• Civil Rights Compliance Plan and/or Civil Rights Compliance Attestation Letter. For more information see: https://dhs.wisconsin.gov/civilrights/Index.htm

Lakeland Care shall exclude organizations from participation in the provider network if any of the following categories are met (references to the Act in this section refer to the Social Security Act).

Entities which could be excluded under section 1128(b)(8) of the Social Security Act are entities in which a person who is an officer, director, agent, or managing employee of the entity, or a person who has a direct or indirect ownership or control interest of 5% or more in the entity, or a person with beneficial ownership or control interest of 5% or more in the entity has:

• Been convicted of any of the following crimes:
  • Program related crimes, i.e., any criminal offense related to the delivery of an item or a service under Medicare or Medicaid. (See Section 1128(a) (1) of the Act);
  • Patient abuse, i.e., criminal offense relating to abuse or neglect of patients in connection with the delivery of health care (See Section 1128 (a) (2) of the Act;
  • Fraud, i.e., a State or Federal crime involving fraud, theft, embezzlement, breach of fiduciary responsibility, or other financial misconduct in connection with the delivery of health care or involving an act or omission in a program operated by or financed in whole or part by Federal, State or local government. (See Section1128 (b)(1) of the Act);
  • Obstruction of an investigation, i.e., conviction under State or Federal law of interference or obstruction of any investigation into any criminal offense described directly above (See Section 1128 (b) (2) of the Act;
  • Offenses relating to controlled substance, i.e., conviction of a State or Federal crime relating to the manufacturing, distribution, prescription or dispensing of a controlled substance. (See Section 1128 (b) (3) of the Act;
• Been excluded from participation in Medicare or a State Health Program. A State Health Care Program means a Medicaid program or any State program receiving funds under title V or title XX of the Act. (See Section 1128(b)(8)(iii) of the Act.)
• Been assessed a Civil Monetary Penalty under Section 1128A of the Act. Civil monetary penalties can be imposed on individual providers, as well as on provider organizations, agencies, or other entities by the DHHS Office of Inspector General. Section 11238A authorizes their use in case of false or fraudulent submittal of claims for payment, and certain other violations of payment practice standards. (See Section 1128(b)(8)(B)(ii) of the Act.)

Lakeland Care shall only contract with providers that:

Meet the Lakeland Care’s provider standards which have been approved by the Department of Health Services (DHS), Division of Long Term Care.

Meet the provider standards in Wisconsin’s approved s. 1915 (c) home and community-based waiver, meet all required licensure and/or certification standards applicable to the service provided, and are consistent with any applicable Department of Health Services, Division of Long Term Care.

We enlist multiple methods to ensure Lakeland Care upholds our mission, maintaining a high quality provider network is a key to that success. Lakeland Care uses several methods to validate our high quality provider network, which include:

• Confirmation of proper licensure
• Current business insurance certificates
• Provider employee background checks
• Certification of facilities as required by state or federal law

For more information about credentialing and re-credentialing please contact the Network Relations Team.

Lakeland Care’s philosophy is to maintain a diverse, quality network of providers to meet the need of our members. Equally, we believe providers should advocate on behalf of the members in tandem with our IDT staff.

Providers will not be terminated from the Lakeland Care network for any of the following reasons:

• Advocating on behalf of the member
• Filing a complaint against Lakeland Care
• Appealing a decision of Lakeland Care
• Requesting a review of or challenging a termination decision of Lakeland Care.

Providers may be terminated from the Lakeland Care network for the following reasons, including, but not limited to:

• Failure to submit materials for re-credentialing within required timeframes
• Suspension, loss or other actions on licensure
• Quality of care or member health and safety concerns
• Provider-initiated termination
• Failure to meet Lakeland Care’s provider contract criteria
• No current business need within the provider’s geographic area, subject to applicable state and federal law.

For more information on any of the items above please refer to your Lakeland Care provider contract or the Lakeland Care Provider Handbook.