Becoming A Provider - Request to Apply   Log Out

Assistance If you are having trouble filling out the provider app you may contact My Choice Family Care as follows: Contact Information During standard business hours (8:00am to 4:30pm) you may call: 414-287-7640 After hours or if you prefer email, use: contractspecialiststaff@mychoicefamilycare.org How to fill out the application: Navigation: Filling out an application involves moving from screen to screen using "Next >" and "< Previous" buttons to navigate. The information you enter will be automatically saved as you switch screens using the Next and Previous buttons. The Overview (starting) screen provides buttons to allow you to jump to a particular screen. In some screens you may also click a "(1 of 5)" indicator at the top of the screen to move directly to a specific screen. Number of Locations: Depending on your business, you may be filling out information for a single location (one address, no sub-businesses) for your entire business or for many locations within a larger organization. A question in the early screens will ask you about which type of business you are in that regard and will lay out the screen flow accordingly. If you only have one location, the next and previous buttons will walk you through the screens of that location seamlessly. If you have multiple locations, you will instead be presented with a Locations list screen to allow you add and update as many locations as you have. Finalizing / Submitting: Finalizing the application is not available until all required information and supporting documents have been provided. You do not have to fill out all information in one visit, but you will not be able to finalize and submit the application until all required information has been provided. The screens will identify missing required information at the top. Please provide as much requested information as you can to assist in the evaluation process. General Application Information: This Service Provider Application and all documentation must be completed and submitted no later than (30) days after the application is started. If it is not completed in that timeframe it will automatically be denied. Understand that the completion of a provider application does not guarantee network admission and/or subsequent contract with the MCO. Please Note: The MCO is not required to contract with providers beyond the number necessary to meet the needs of its members. Login Welcome to the path for becoming a My Choice Wisconsin provider. You will first have to fill out and submit a request to apply. If approved, you will then go through a more comprehensive Provider Application process. For existing users, login below to access your request information. For new applicants, click the New Application Registration button to register. Request to Apply Started: Last Updated: Existing User Login User Login:   Password:     NOTE: The My Choice Family Care website will be down the weekend of 7/12 through 7/14 for server upgrades. Please try again on 7/15. If you have any questions, click 'Need Assistance?' at the top of the page.