Lakeland Care District
(920) 906-5100
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Lakeland Care District
Provider Network Team
District-wide
Megan A Acheson
Employment Services Coordinator
N6654 Rolling Meadows Drive
Fond du Lac, WI 54937
920.906.5181 phone
920.906.5103 fax
megan.acheson@lakelandcaredistrict.org
Jill Krzanowski, BSW, MS-OLQ
Provider Network Director
N6654 Rolling Meadows Drive
Fond du Lac, WI 54937
920.906.5127 phone
920.251.3581 cell
920.906.5103 fax
jill.krzanowski@lakelandcaredistrict.org
Central Office
N6654 Rolling Meadows Drive
Fond du Lac, WI 54937
Tricia Bonlander
Provider Network Specialist
920.906.5171 phone
920.906.5103 fax
tricia.bonlander@lakelandcaredistrict.org
West Office
500 City Center
Oshkosh, WI 54901
Greg Schlichting
Provider Network Specialist (for all Residential/Supported
Apartments/Nursing Home providers)
920.456.3257 phone
920.456.3201 fax
greg.schlichting@lakelandcaredistrict.org
Lorie Ruck
Provider Network Specialist (for all NON-residential providers)
920.456.3217 phone |
920.456.3201 fax
Lorie.ruck@lakelandcaredistrict.org
East Office
3415 Custer Street
Manitowoc, WI 54220
Molly Burke
Provider Network Specialist
920.652.2181 phone
920.652.2441 fax
Molly.burke@lakelandcaredistrict.org
District-wide Authorizations, Member Billing, Claims & Appeal
Inquiries
Lori Konkel
920.906.5852 phone
lori.konkel@lakelandcaredistrict.org
Applications
102 Adult Day Care 103 Respite 104 Supported Apt Services 104 Supportive Home Care 105 Home Health 107 Transportation 108 Pre-Vocational Services 110 Daily Living Skills Training 112 DMS DME Adaptive Aids 112 Home Modifications 112 Personal Emergency Response Services (PERS) 202 Private AFH 402 Home Delivered Meals 403 Alternate Therapy 505 Nursing Home 506,711,202 Residential Services 507 Counseling-Therapy 615 Supported Employment 619 Financial Management Services 706 Day Service
Residential Provider Face Sheet
Provider Background Checklist
Residential Computation Worksheet
Residential Salary Allocation Worksheet
Residential Weekly Staff Schedule
Residential Facility Rate - Instructions
Residential Member - Staff Scheduling Form
2012 Addendums
102 Adult Day Care 103 Respite 104 Supportive Home Care 104 Supported Apartment Program 107 Transportation 108 Pre-Vocational Services 110 Daily Living Skills Training 112 Personal Electronic Monitoring and Response Services 202 Certified AFH 202 Licensed AFH 402 Home Delivered Meals 505 Nursing Home 506 CBRF 615SupportedEmployment 706 Day Services 711 RCAC
Materials
Sample Debarment
Policy
Sample
Debarment Attestation Letter
Sample Background Check Attestation Letter
Sample Letter of Authorization
Sample Letter of Authorization - package category
Sample Letter of Authorization - PDME
Elements of a Clean Claim
Claim Appeal
Process
Sample Billing Form
Sample Billing Form (Excel Version)
Civil Rights Compliance Plan Letter of Assurance
Civil Rights Information:
http://dhs.wisconsin.gov/civilrights/Background Check Information: http://dhs.wisconsin.gov/caregiver/EmplContrs.htm
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