Interested in becoming a WPS Preferred Provider?

• WPS New Provider Assessment Request FormSuClaim

Preferred Provider Updates

(Updates for providers that are already Preferred Providers)

• Add Individual Provider Form
• Update Individual Provider Form
• Add New Clinic/Facility Form
• Update Clinic/Facility Form
• Termination of Clinic/Facility Form

Preauthorization Forms

• Inpatient Pre-Certification Guidelines
• Outpatient Pre-Authorization Guidelines
• Medical Preauthorization Request Form

Outpatient Behavioral Health Treatment Plans

• Initial Treatment Plan
• Follow-Up Treatment Plan

HIPAA Forms and Documents

This provides a collection of HIPAA forms and documents, particularly those regarding PHI (Personal Health Information).

• Notice of Privacy Practices
• Appeals/Grievance Authorized Representative Form
• Authorization for WPS to Disclose Health Information
• General Authorization to Use and Disclose Health Information
• Request to Access PHI
• Request to Amend PHI

Miscellaneous Forms

• Understanding Your EOB
• Utilization Management/Quality Management Program and Procedures