Smoking Cessation Treatment Services – Coverage & Billing Procedures
For coverage and billing procedures on smoking cessation treatment services, please see chapter 8, section 4, page 8-302 of the IHCP provider manual. MDwise SMOKE-free resources for providers, like the Tobacco Cessation Toolkit and Indiana Tobacco Quitline forms, can be found at MDwise.org/providers/smokefree.
myMDwise Provider Portal: Eligibility Update
MDwise apologizes that a recent update to the myMDwise provider portal had the unintended consequence of posting eligibility information that providers may find confusing. Read the full notice.
Effective June 1, 2014: State of Indiana to Implement Eligibility Changes to the Aged, Blind and Disabled Medicaid Program
As announced in Indiana Health Coverage Programs (IHCP) Provider Bulletin BT201417, the IHCP is changing the way individuals are determined eligible for IHCP coverage under the aged, blind or disabled aid categories. Read more.
Behavioral Health MDwise Marketplace Providers
Learn about the top five reasons for denials and how to fix these common reasons for denial.
MDwise Total Health will be changing the toll free prior authorization fax number for Hoosier Healthwise and Healthy Indiana Plan effective June 2, 2014. This change will enable MDwise Total Health to more efficiently receive the faxes for prior authorization directly into the prior authorization database. Read more.
New Web Resource Guide for Care Select Providers
In February 2014, MDwise was selected by the State of Indiana to continue to serve as a Care Management Organization for the Indiana Care Select Program. Indiana Care Select is comprised of these two components: Care Management and administration of the Indiana Chronic Disease Management Program.
Care Select providers, use the the Care Select MDwise Web Resources Guide to find helpful information.
Revised CMS-1500 (02/12) Claim Form
Effective April 1, 2014, only the revised version of the CMS-1500 (02/12) paper claim form will be accepted. Paper claims submitted on the current version of the CMS-1500 (08/05) form after March 31, 2014 will not be processed and will be returned to the provider. Providers will be asked to resubmit on the revised claim form.
In addition, ICD indicators are required on all UB-04 and revised CMS-1500 forms. Missing or invalid ICD-10 indicators is one of the top reasons claims can't be processed and are returned to providers.
For more information please see IHCP Banner BR201411.
Important Information Regarding the MDwise Marketplace Pharmacy Benefit
Certain prescription drugs in the MDwise Marketplace formulary require prior authorization through PerformRx. View the MDwise Marketplace formulary
. Please be advised that the formulary labels each drug with its corresponding copay tier but providers must click on the drug link to determine if the drug requires step therapy, has certain prior authorization guidelines or has other restrictions such as a limited quantity.
Faxed prior authorizations should use the appropriate pharmacy prior authorization form found at MDwise.org/forms/pharmacy
. Please note that certain drugs have their own prior authorization form.
If you are submitting a prior authorization for a medication that your patient was using before enrollment in MDwise Marketplace and the desired outcomes were being achieved, please document this in detail on the prior authorization form. This will allow the request to be considered for continuity of care.
Prior authorization requests can be faxed to PerformRx at 855.811.9324. Urgent prior authorization requests should be faxed to 855.811.9325. Please call PerformRx provider services at 855.491.0633 if you have any questions.
New MDwise Marketplace Prior Authorization Form
Based on provider feedback MDwise has updated our Marketplace prior authorization form for medical and behavioral health authorizations. The updated form can be found in the prior authorization section of our provider forms page at MDwise.org/forms/priorauthorization
Attention Select Health Network Providers for Hoosier Healthwise and Healthy Indiana Plan (HIP)
Effective March 15, 2014, MDwise Select Health Network will be changing prior authorization vendors for Hoosier Healthwise and HIP. Read more.
Attention Hoosier Healthwise, Healthy Indiana Plan (HIP) and MDwise Marketplace Behavioral Health Providers
As of February 1, 2014, MDwise will no longer require prior authorization for outpatient behavioral health services for Hoosier Healthwise, Healthy Indiana Plan and MDwise Marketplace.
Hoosier Healthwise and HIP