Join Our Network
Community Care offers member-centered care to seniors and adults with intellectual and physical disabilities in eastern Wisconsin. We are the only Wisconsin organization to offer all three long-term care programs: Family Care, Partnership and the Program of All-Inclusive Care for the Elderly (PACE).
We are always looking to add providers to our network who share Community Care’s mission to deliver quality, cost-effective care to the members we serve. We review our network needs before proceeding with applications. If we determine that there is not a current need for the service(s) you offer, we will notify you and keep your application on file.
Effective 9/16/24, adult long-term care (LTC) waiver service providers are now able to enroll as Wisconsin Medicaid providers. Community Care requires that providers have a Medicaid number when submitting an application for consideration, unless there is an alert with exceptions on the Forward Health website. Information regarding the Provider Enrollment System for Adult Long Term Care can be found here:
Community Care highly recommends providers attend an Application Training Session. These trainings are required for any provider whose application has been denied and are looking to reapply.
If you have questions or need confirmation as to which application you should complete, call 1-866-937-2783 and select option 2.
Download an application below to get started:
General Application: Word, PDF
Owner-Occupied Adult Family Home (OOAFH) Application: Word, PDF
Transportation Provider Application: Word, PDF
Health Care Group Application: Word, PDF
Application Forms
- Attestation Form (Word or PDF format) to be completed by all providers
- W-9 Form (to be completed by all providers)
- Residential Data Collection (to be completed by all corporate residential providers and submitted with the General Application)
- Residential Summary (Word or PDF format) to be completed by all residential providers
- Electronic Funds Transfer Form ( Word or PDF format) with a cancelled or voided check
Note: Community Care will not accept photos or screenshots of any application materials.
Submit completed application materials to:
Community Care, Inc.
ATTN: Provider Management
1801 Dolphin Drive
Waukesha, WI 53186
or Fax: (262) 446-6707
