Indiana Care Select Provider Tools
Clinical Health Guidelines NEW!
Asthma
Chronic Kidney Disease
Chronic Obstructive Pulmonary Disease
Congestive Heart Failure (CHF)
Coronary Artery Disease
Diabetes
Claims Payment and Denial Questions
HP 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 HP located in Chapter One of the Indiana Medicaid Provider Manual. Learn more (pdf)
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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 
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Member Eligibility
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 (pdf).
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.
Pharmacy Resources
Obtain pharmacy claim forms online
View Care Select pharmacy formulary
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 (pdf).
HP is responsible for accepting and processing pharmacy claims for the Care Select Program. To obtain billing information for pharmacy claims from HP consult the IHCP Provider Manual, Chapter 9.
Prior Authorization
Find Help Completing Your Prior Authorization Form New!
Indiana Health Coverage Programs Provider Manual Ch 6, see Section 2 for manual paper PA completion instructions are explained in detail.
Please use the forms listed below to submit PA to for MDwise Care Select members
Prior Authorization - System Update Request 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 Review and Authorization Dental Request Form
Use this form to submit requests for prior authorization for any dental service which requires prior authorization.
Prior Review and 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.
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.
Care Management/Disease Management
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. Learn more.
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
Restricted Card
Based on utilization practices or referrals by providers or other agencies, it may be appropriate to place a member in the Restricted Card Program.
Providers can learn more about Restricted Card by viewing the Restricted Card Presentation.
Network Composition and Referral Policies for MDwise Care Select
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 HP 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 HP 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.
Accessibility