March 1, 2016
Effective March 1, 2016:
primary medical providers (PMP), specialists, behavioral health providers and hospitals in the Community Health Network are included in the MDwise provider network for Hoosier Care Connect and MDwise Marketplace members. Please contact MDwise provider relations at 317-822-7300 ext. 5800
or by visiting the Contact Us
April 13, 2016
An updated version of the 2016 Marketplace Prior Authorization list has been posted to the MDwise website. The new version contains an updated list of medical benefit drugs that require prior authorization.
The updated MDwise Marketplace PA list is located here
January 26, 2016
Required Diagnosis Codes for Prior Authorization Requests
(Effective for dates of services on or after 10/1/2015)
To avoid delays in the processing of your authorizations, please ensure you are utilizing appropriate, ICD-10 diagnosis codes with your Prior Authorization request.
As a reminder, ICD-10 diagnosis codes often require four to seven characters
to be considered a valid code.
The example below illustrates non-billable header codes that contain up to five characters. In this instance, the billable codes that contain six characters would be more appropriate.
- G43 – Migraine
- G43.0 – Migraine without aura
- G43.00 – Migraine without aura, not intractable
- G43.001 – Migraine without aura, not intractable with status migrainosus
- G43.009 – Migraine without aura, not intractable without status migrainosus
Please feel free to distribute this message to your coding and/or precertification teams. Additional prior authorization resources are available on the MDwise website
January 20, 2016
Prior Authorization Required for Substitutable Brand Name Drugs
Beginning on January 21, 2016, MDwise Medicaid (Healthy Indiana Plan and Hoosier Care Connect) prescriptions for which the prescriber has indicated "Brand Medically Necessary" will follow a new procedure for review and determination. Pharmacies will no longer be able to submit the claim with a DAW code of 6 or 9 for these prescriptions. For consideration of 'Brand Medically Necessary' claims, the prescriber will be required to submit a prior authorization request. Those requests will be considered within 24 hours.
Prescribers should use the Brand Medically Necessary Form
located on the Pharmacy Forms page of the MDwise website.
December 28, 2015
There are important changes coming to the Hoosier Care Connect program. Starting on January 1, 2016, Hoosier Care Connect members will begin paying copays.
For more information, see the letter sent to providers
December 15, 2015
MDwise Corporate will be transitioning MDwise Excel Network Hoosier Healthwise prior authorization to our existing Prior Authorization system starting on January 1, 2016.
Since 11/16/15, new Hoosier Healthwise prior authorization requests for 2016 dates of service are already being inputted in the system. In an effort to ensure a seamless transition, steps have been taken to capture all authorizations which span from 2015 into 2016. However, if a provider receives a claim denial due to no authorization on file where services were part of an authorization which continued from 2015, please take the following steps to resolve the issue:
Follow the steps on the claim Explanation of Benefit to file a claim dispute. Please refer to MDwise.org
for the Claim Dispute form and process.
With your claim dispute, provide any documentation you may have of previously obtaining prior authorization for these dates of service. If you have any questions, please don’t hesitate to contact us at 800-356-1204