WISe forms & monthly tracker submission

Forms & information about submitting Wraparound with Intensive Services (WISe) to MCOs will be posted here as it is received.

MCO WISe Provider Education update PPT - includes contact information


WISe members are submitted monthly to Molina via the “Member Summary” tab on each BH Agency’s WISe invoice.

Coordinated Care

From Mindy Watson (Mindy.L.Watson@coordinatedcarehealth.com)

I would like to take this opportunity to go over Coordinated Care specific monthly WISe tracker that will be completed each month by our contracted WISe providers:
WISe Reporting Tracker excel
WISe Notification Form 2019_Fillable

Please refer to our website https://www.coordinatedcarehealth.com/providers.html for the most up to date forms.

 WISe monthly tracker  

  • This monthly spreadsheet will be completed by each WISe provider.

  • The WISe provider will list all of the Coordinated Care members currently receiving or waiting for WISe services for the specified month.

  • This is used to track and report WISe numbers; capacity and is in some contracts used for payment purposes. Please refer to your contract on any questions or specifics in regards to billing. 

  • The Wise tracker will be completed each month. This is due by the 10th of the following month of service. For example, for the month of January, the WISe tracker will be due no later than February 10th.

  • The WISe tracker will be submitted to the following email SOCTeam@coordinatedcarehealth.com.

If your agency is not able to send an encrypted/secure email and would like to set up a SFTP web portal for submittal, please contact John Cooper (JOCOOPER@coordinatedcarehealth.com) by email to make this request and CC Mindy.L.Watson@coordinatedcarehealth.com in this email.

The MCO’s have worked together to have a similar reporting format and spreadsheet to simplify this process for WISe providers.

Please feel free to reach out to the identified contacts within each MCO for additional information.


To be received


To be received