Provider Orientation

Welcome to MHS Health Wisconsin. We thank you for being part of our network of participating physicians, hospitals and other healthcare professionals.

To complete a provider orientation training click on the link below to review the Orientation presentation. Then, submit the form to verify the training was completed.

Provider Orientation Training (PDF)

Provider Orientation Training Confirmation

Provider Group Name *

Provider Tax ID (TIN) *

Provider Tax ID (TIN) 2

Provider Tax ID (TIN) 3

Provider Tax ID (TIN) 4

Provider Tax ID (TIN) 5

Training Completed By *

Email *

Phone * Please enter numbers only, no dashes or hyphens

Title *

Date *

Do you know who your Provider Relations Rep is? * Yes No

Do you have additional questions and want to be contacted by your Provider Relations Rep? * Yes No

Please assist us with keeping current contact information on file for your agency. Complete the following information:

Contracting Contact – First Name

Contracting Contact – Last Name

Contracting Contact – Title

Contracting Contact – Phone Please enter numbers only, no dashes or hyphens

Contracting Contact – Email

Claims/Billing Contact – First Name

Claims/Billing Contact – Last Name

Claims/Billing Contact – Title

Claims/Billing Contact – Phone Please enter numbers only, no dashes or hyphens

Claims/Billing Email

Training Confirmation * The Provider Orientation training has been completed by the Provider Group above.