Implementing Wisconsin Medicaid Pharmacist Provider Status within Health System Ambulatory Clinics
by Megan M. Clement, PharmD, BCACP, Amy L. Mahlum, PharmD, BCACP, Jennifer J. Foti, PharmD, BCACP
Abstract:
Introduction: As of July 1, 2024, pharmacists in the state of Wisconsin could begin enrolling as medical billing providers and submit claims for services provided to patients with Wisconsin Medicaid insurance coverage. This project assisted Wisconsin-based health system ambulatory clinics with the implementation of new provider status workflows, with a goal of facilitating increased patient access to care, allowing pharmacists to bill for services, and helping to justify pharmacist presence in ambulatory clinics. This project can serve as a guide for other ambulatory clinics to implement pharmacist provider status.
Methods: A gap analysis was performed based on the Pharmacy Society of Wisconsin’s (PSW) Pharmacist Provider Status Implementation Guide. Key stakeholders throughout the health system were identified. Each pilot pharmacist obtained credentialing through the system medical group and had their profile updated to a provider template within the electronic health record (EHR). Standardized documentation for clinic encounters was created, additional training for pilot pharmacist providers was completed, and a playbook was developed to facilitate future pharmacist provider enrollment.
Results: Out of the 18 gaps identified in the original gap analysis, 4 gaps were already closed before the start of the residency year-long project, 13 gaps were closed from June 2024 to July 2025, and 1 gap is still pending, as post-implementation evaluation is ongoing.
Conclusions: This project successfully piloted the implementation of Wisconsin Medicaid pharmacist provider status at six Wisconsin-based health system ambulatory clinic locations and established a replicable model to facilitate expansion to new and existing ambulatory spaces across the health system.
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2026 May/June Table of Contents
Abstract:
Introduction: As of July 1, 2024, pharmacists in the state of Wisconsin could begin enrolling as medical billing providers and submit claims for services provided to patients with Wisconsin Medicaid insurance coverage. This project assisted Wisconsin-based health system ambulatory clinics with the implementation of new provider status workflows, with a goal of facilitating increased patient access to care, allowing pharmacists to bill for services, and helping to justify pharmacist presence in ambulatory clinics. This project can serve as a guide for other ambulatory clinics to implement pharmacist provider status.
Methods: A gap analysis was performed based on the Pharmacy Society of Wisconsin’s (PSW) Pharmacist Provider Status Implementation Guide. Key stakeholders throughout the health system were identified. Each pilot pharmacist obtained credentialing through the system medical group and had their profile updated to a provider template within the electronic health record (EHR). Standardized documentation for clinic encounters was created, additional training for pilot pharmacist providers was completed, and a playbook was developed to facilitate future pharmacist provider enrollment.
Results: Out of the 18 gaps identified in the original gap analysis, 4 gaps were already closed before the start of the residency year-long project, 13 gaps were closed from June 2024 to July 2025, and 1 gap is still pending, as post-implementation evaluation is ongoing.
Conclusions: This project successfully piloted the implementation of Wisconsin Medicaid pharmacist provider status at six Wisconsin-based health system ambulatory clinic locations and established a replicable model to facilitate expansion to new and existing ambulatory spaces across the health system.
Download PDF
2026 May/June Table of Contents