Welcome Providers

Welcome to the MDwise network. We value your participation and hope to keep you informed by providing easily accessible resources and updates here. Information about MDwise guidelines, requirements and policies and procedures can be found in the provider manual.
 

MDwise Quick Contact Guides

View our comprehensive quick contact guide that includes delivery system contact information for Hoosier Healthwise, Healthy Indiana Plan and Hoosier Care Connect. 

View our comprehensive Prior Authorization quick contact guide that includes delivery system PA contact information for Hoosier Healthwise, Healthy Indiana Plan and Hoosier Care Connect.

Click here for the MDwise Marketplace quick contact guide with contact information for MDwise Marketplace claims, pharmacy services, provider services and more.

 

News and Announcements


December 1, 2016

A new Electronic Funds Transfer (EFT) Agreement Form and Instructions for Hoosier Healthwise, HIP and MDwise Marketplace were posted to the MDwise website. They can be accessed below:

MDwise Claims Forms




November 21, 2016

Attention MDwise Medicaid Providers: The State and the three managed care entities (MCEs) that service Indiana Medicaid members (both HIP and HCC) have developed utilization management criteria to address the growing epidemic of opioid misuse, abuse, and addiction. Fee-For-Service Medicaid (OptumRx) has had these new opioid UM criteria in place for some weeks and the Indiana Medicaid MCEs are following suit in cooperation with the State.
 
This universal opioid UM initiative is being rolled out in a phased approach and will be complete by 1/1/2017. 

To read more information, view the full provider announcement.



November 17, 2016

Over the next several weeks, MDwise will be implementing some changes to our pharmacy network. These changes will affect both the traditional retail (non-specialty) as well as specialty pharmacy networks. 

Traditional (non-specialty) Retail Pharmacy network
  • CVS and Target will no longer be in the MDwise Pharmacy Network
  • All other IHCP-eligible pharmacies will remain in the network.
  • Walgreens will become the anchor for the MDwise pharmacy network

Click here to see the letter sent to MDwise providers with more information.



November 2, 2016


Download MDwise Marketplace announcement as PDF

MDwise would like to notify providers of changes in the claim submission for MDwise Marketplace Network claims. For your MDwise Marketplace claims with dates of services on or after January 1, 2017, please use the following addresses and submission information:
 

MDwise Marketplace Claims Address

PO Box 331428
Corpus Christi, TX 78463-1428
 

MDwise Marketplace Claims Inquires

1-855-417-5615
 

MDwise Marketplace Electronic Claims

Change Health/ Emdeon / WebMD Payer ID: 45627

Providers will need to make necessary changes to their billing software and processes to account for a change in payer for MDwise Marketplace claims.



November 2, 2016


Download Hoosier Healthwise, HIP and Hoosier Care Connect announcement as PDF

MDwise would like to notify providers of changes in the claim submission for MDwise Hoosier Healthwise, Healthy Indiana Plan and Hoosier Care Connect claims. For your MDwise claims with dates of services on or after January 1, 2017, please use the following addresses and submission information:

Impacted Hoosier Healthwise Delivery Systems Include:
  • MDwise Excel Network
  • MDwise IU Health
  • MDwise Total Health
  • MDwise Community Health Network
  • MDwise Eskenazi
 
All Healthy Indiana Plan and Hoosier Care Connect claims submissions should be sent to the claims address below regardless of Delivery System. 
 
Hoosier Healthwise
MDwise Hoosier Healthwise Claims
P.O. Box 331550
Corpus Christi, TX 78463-1550
Change Health/ Emdeon / WebMD Payer ID: 35191
Claims Inquiries: 1-800-356-1204
 
MDwise HHW Family Planning Claims
P.O. Box 331550
Corpus Christi, TX 78463-1550
Change Health/ Emdeon / WebMD Payer ID: 35191
Claims Inquiries: 1-800-356-1204
Healthy Indiana Plan
MDwise HIP Claims
P.O. Box 331609
Corpus Christi, TX 78463-1609
Change Health / Emdeon / WebMD Payer ID: 31354
Claims Inquiries: 1-800-356-1204
Hoosier Care Connect
MDwise Hoosier Care Connect Claims
P.O. Box 331538
Corpus Christi, TX 78463-1538
Change Health/Emdeon / WebMD Payer ID: 91313
Claims Inquiries: 1-800-356-1204

Providers will need to make necessary changes to their billing software and processes to account for a change in payer for MDwise Hoosier Healthwise claims.
 
Special Note: Claims payment for Hoosier Healthwise (Medical & Behavioral Health) for St. Vincent, St. Margaret Mercy, St. Catherine, and Select Health network remains unchanged. Please refer to the table above for Family Planning submission changes.

The MDwise quick contact guide posted at MDwise.org will be updated to reflect the above changes. 




June 23, 2016


Effective July 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 MDwise Hoosier Healthwise and Healthy Indiana Plan. Please contact MDwise provider relations at 317-822-7300 ext. 5800 or by visiting MDwise.org/quickcontact.



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 page.



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.



November 17, 2015

Effective immediately, MDwise will reprocess claims for Healthy Indiana Plan (HIP), Presumptive Eligibility (PE) HIP and Hoosier Care Connect that were denied or rejected for reasons of eligibility or authorizations for dates of service (DOS) from February 1, 2015 through October 1, 2015. 

For more information see the
 letter sent to providers.

View archived news and announcements