Looking for Forms? See
above for the new Forms area.
EDS is the State's primary fiscal agent and
processes claims for the Care Select Program
and Traditional Medicaid. Providers who experience
claim denials for MDwise Care Select members
should follow the Provider Avenues of Resolution
developed by EDS located in Chapter One of
the Indiana Medicaid Provider Manual. Learn
more.
Providers who have questions regarding prior
authorization, care management, disease management,
the Restricted Card Program, or provider relations
for the MDwise Care Select Program,
should view
the MDwise Care Select Quick Contact
Sheet.
Verifying eligibility in any IHCP Program is
important to determine whether the member
is eligible and what managed care entity the
member is affiliated with. Learn
more.
Care Select members who are affiliated
with MDwise Care Select and a MDwise Care
Select PMP will be identified in the
managed care information section of web interchange
or OMNI.
MDwise looks forward to working with those providers
who provide medical care to our members. Providers
who use web interchange may determine
member eligibility online.
New providers may
learn more about MDwise, its health
plans, and how we operate in Care
Select, Hoosier
Healthwise, or the Healthy
Indiana Plan by visiting http://www.mdwise.org and
selecting the appropriate tab.
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Affiliated Computer Systems (ACS) is responsible
for reviewing Pharmacy PA requests for the
Care Select pharmacy program as well as administrating
the drug rebate program. View
ACS pharmacy, PA contact information or rebate
contact information.
EDS is responsible for accepting and processing
pharmacy claims for the Care Select Program.
To obtain billing information for pharmacy
claims from EDS consult
the IHCP Provider Manual, Chapter 9.
MAIL OR FAX
MDwise is contracted to provide prior authorization
(PA) services to MDwise Care Select members.
Providers may submit PA forms by mail
or fax.
WEB INTERCHANGE
Providers may also use web interchange if their
specialty is allowed to submit PA requests
via web interchange (see Chapter 6 of the
IHCP Provider Manual for a list of approved
specialties who may submit PA requests via
web interchange).
For helpful hints regarding the MDwise PA process,
providers may view
the MDwise PA Quick Reference Guide or
the MDwise Prior Authorization and Care
Management Training Presentation. 
CARE SELECT PA FORMS
Please use the forms listed below to submit PA to for MDwise Care Select members
Prior Authorization Request Form: Use this form to submit non dental initial PA request for services that require PA in the Care Select Program. Please note: Do not submit an MDwise Hoosier Healthwise Prior Authorization form for any MDwise Hoosier Healthwise delivery system for the Care Select Program.
Prior Authorization System Update Form: Use this form to correct any clerical errors made on the non dental initial PA request form or to extend the date span on a PA that is already approved. Do not use this form to request a new prior authorization. Only use this form for Care Select Program members.
Prior Authorization Dental Request Form: Use this form to submit requests for prior authorization for any dental service which requires prior authorization.
More Prior Authorization Information
Visit the IHCP fee schedule to determine what service requires PA in Care Select.
Submit your PA request online using web interChange.
Get MDwise Care Select PA Unit contact information.
Find PA Forms Online
Find the Care Select Prior Review and Authorization Form, Care Select Prior Authorization – System Update Form and the Care Select Prior Review and Authorization Dental Form.
Questions regarding the use of web interChange should be directed to the EDS Electronic Solutions Helpdesk at 1-877-877-5182 or 317-488-5160.
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Sign
up for CareConnect NX.
Already signed up for CareConnectNX? Login
now.
Get
more info about CareConnectNX.
The CareConnectNX™ (CCNX) web application gives authorized PMPs and care partners secure access to view the assessment data and care plans of their MDwise Care Select member panel. Learn more.
One of the hallmark changes to managed care
for the Care Select population is use of care
managers to improve the health outcomes and
quality of life for MDwise Care Select members.
Care Select members typically suffer from
chronically poor health that requires intensive
and complex treatment regimens.
MDwise care management services offer a diverse,
intensive, and coordinated approach to improving
the health outcomes and therefore the quality
of life for MDwise Care Select members.
Care management goals include:
1. Treatment regimens for chronic illnesses
that conform to evidence – based guidelines
2. PMPs should be more aware of and incorporate
knowledge of functional assessments, behavioral
changes, self-care strategies, and methods
of addressing emotional or social distress
into overall patient care
3. Care should be less fragmented and more holistic
(i.e. addresses physical and behavioral health
care needs and in considering both medical
as well as social needs), and there should
be communication across settings and providers.
4. Patients and their families/caregivers should
have more involvement in the development and
implementation of treatment plans.
Learn more about Care Management
Services at MDwise
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Network Composition
Currently, the Office of Medicaid Policy and
Planning (OMPP) requires only primary medical
providers (PMPs) to enroll in MDwise Care
Select. Specialists, hospitals, and ancillary
providers that have an active IHCP provider
number and provider agreement in force with
EDS can see MDwise Care Select member and
are not required to sign a provider agreement
addendum with MDwise Care Select at this time.
This is subject to change based on future decisions
by OMPP. Please watch for future communication
from MDwise and EDS regarding any changes
to this policy.
Network Referrals
MDwise Care Select PMPs may refer to any IHCP
enrolled provider based the medical need of
the member.
Find
an IHCP enrolled specialist, hospital, or
ancillary provider online.
The Care Select member’s assigned Primary
Medical Provider (PMP) is responsible for
providing or authorizing referrals to medical
specialists for a member’s medical care
according to the guidelines specified in the
Indiana Health Coverage Programs (IHCP) Provider
Manual Chapter 1, Section 1 (certain medical
services require PMP authorization and are
outlined in this section).
This PMP authorization may be in addition to
any required IHCP Prior Authorization requirements
for certain services as outlined in Chapter
6 of the IHCP Provider Manual. This process,
known as the “gatekeeper approach”,
allows PMPs to refer members for medically
appropriate and reasonable care that they
cannot provide and requires specialists enrolled
in the IHCP to seek the PMP’s certification
code prior to rendering
or delivering those services in order to receive
payment.
Specialists (including hospital emergency room
visits where the condition upon medical evaluation,
is deemed to not be a true medical emergency – see
the IHCP Provider Manual Chapter 8, Section
2, Outpatient Services, for further information
on emergency services) who are not authorized
by the Care Select member’s PMP to render
or deliver services, must refer that member
back to the member’s assigned PMP for
care.
When members request services where the member’s
assigned PMP has declined to release the certification
code, those services are considered non-covered
by the IHCP and the provider must inform the
member the service is non-covered and follow
the guidelines outlined in Chapter 4, Section
5 of the IHCP Provider Manual prior to billing
the Care Select member for non-covered services.
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