Skip to content
FacebookLinkedInInstagramTwitter
  • COVID-19 INFO
  • Find a provider
  • Contact Us
  • Provider Portal
Inclusa – Managed Care Organization – Family Care – Wisconsin – Commonunity Logo Inclusa – Managed Care Organization – Family Care – Wisconsin – Commonunity Logo
  • About
    • Blog
    • Board of Directors
    • Careers
    • CMS Patient Access API
    • Contact Us
    • Leadership Team
    • Locations
    • Notice of Privacy Practices
    • Report Fraud & Abuse
    • Vision, Mission & Values
  • Members & Family
    • How To Enroll
    • Member Handbook
    • Resources
    • X-Plain Health Resources
  • Providers
    • Aging Mastery Program
    • Claims & Billing
    • Contracting
    • Provider Announcements
    • Provider Partners
    • Provider Portal
    • Request for Proposals
    • Resources
  • Commonunity®
    • Aging Mastery Program
    • Commonunity® Overview
  • Community Resources

Contracting

Home/Providers/Contracting
ContractingInclusa2022-11-28T19:22:47+00:00

Application and Contracting Reference

  • Provider Training: Inclusa Provider Development, Contracting, and Credentialing Policies

Application Forms

  • Provider Application
  • W-9 Form
  • Background Information Disclosure (BID)
  • Owner Occupied Adult Family Home (AFH) Certification Application
  • AFH Certification Application Community Care Home
  • Residential Provider Service Form
  • Provider Application-Service Location Form

Contract Appendix C: Provider Insurance Coverage Minimums

  • Contract Appendix C – Provider Insurance Coverage Minimums

Contract Appendix N: Scope of Service

  • Adaptive Aids – Service Dogs
  • Adult Day Care
  • Community Support Program (CSP)
  • Community Supported Living (CSL)
  • Consultative Clinical and Therapeutic Services
    for Caregivers
  • Consumer Directed Supports (SDS) Broker
  • Consumer Education and Training
    (includes Mental Health Peer Specialists)
  • Counseling & Therapeutic Resources (Non-MA)
  • Daily Living Skills Training
  • Day Habilitation Services (Adult Day Services)
  • Environmental Accessibility Adaptations
    (Home Modifications)
  • Financial Management Services – Representative Payee
  • Financial Management Services for Self-Directed Supports
  • Home Delivered Meals
  • Home Health
  • Housing Counseling
  • Independent Nursing
  • Mental Health-AODA
  • Personal Emergency Response System (PERS)
  • Physical and Occupational Therapy, Speech & Language Pathology
  • Prevocational Services
  • Residential Services – Adult Family Home (AFH)
  • Residential Services – Community Based Residential Facility (CBRF)
  • Residential Services – Residential Care Apartment Complex (RCAC)
  • Supported Employment
  • Supportive Home Care
  • Supportive Home Care – Chore Services
  • Supportive Home Care – Days
  • Training for Unpaid Caregivers
  • Transportation (Specialized Transportation)
  • Vocational Futures Planning & Support (VFPS)

Phone: 877-622-6700
TTY: 711
Offices: click here

After-Hour Authorizations
Monday-Friday: Before 8am & After 4:30pm
Weekends & Holidays: All Day

Mailing Address:
2801 Hoover Rd, Unit 3
Stevens Point, WI 54481

Copyright 2019 Inclusa, Inc. | All Rights Reserved
FacebookLinkedInInstagramTwitter
en English
af Afrikaanssq Albanianam Amharicar Arabichy Armenianaz Azerbaijanieu Basquebe Belarusianbn Bengalibs Bosnianbg Bulgarianca Catalanceb Cebuanony Chichewazh-CN Chinese (Simplified)zh-TW Chinese (Traditional)co Corsicanhr Croatiancs Czechda Danishnl Dutchen Englisheo Esperantoet Estoniantl Filipinofi Finnishfr Frenchfy Frisiangl Galicianka Georgiande Germanel Greekgu Gujaratiht Haitian Creoleha Hausahaw Hawaiianiw Hebrewhi Hindihmn Hmonghu Hungarianis Icelandicig Igboid Indonesianga Irishit Italianja Japanesejw Javanesekn Kannadakk Kazakhkm Khmerko Koreanku Kurdish (Kurmanji)ky Kyrgyzlo Laola Latinlv Latvianlt Lithuanianlb Luxembourgishmk Macedonianmg Malagasyms Malayml Malayalammt Maltesemi Maorimr Marathimn Mongolianmy Myanmar (Burmese)ne Nepalino Norwegianps Pashtofa Persianpl Polishpt Portuguesepa Punjabiro Romanianru Russiansm Samoangd Scottish Gaelicsr Serbianst Sesothosn Shonasd Sindhisi Sinhalask Slovaksl Slovenianso Somalies Spanishsu Sudanesesw Swahilisv Swedishtg Tajikta Tamilte Teluguth Thaitr Turkishuk Ukrainianur Urduuz Uzbekvi Vietnamesecy Welshxh Xhosayi Yiddishyo Yorubazu Zulu
Go to Top