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.
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
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 serviceIf 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.
November 2, 2015
MDwise is now offering a new service to Healthy Indiana Plan providers. Using the MDwise Prepayment Tool on myMDwise
, providers can get prepayment for services rendered up front.
Benefits of using the MDwise Prepayment Tool
Provider types that can use the MDwise Prepayment Tool include the following:
- Providers get prepayment for services rendered.
- Members have accountability and visibility to their health care costs.
- The new tool helps providers identify what services require prior authorization.
- There are no additional costs or equipment required to use this tool.
*Note: Dental providers can use the MDwise Prepayment Tool and provide member receipts using the DentaQuest system, however they will not receive direct payment from the POWER Account.
Learn more about how to sign up for this new service today
- Behavioral health providers.
- Health clinics.
- Physician offices.
- Vision providers.
- Dental providers.*
If you have questions, please contact MDwise provider relations at 317.822.7300 ext. 5800.
October 30, 2015
MDwise would like to notify providers of a change in the claim submission for MDwise Excel Network (formerly known as Hoosier Alliance) Hoosier Healthwise claims.
View the letter sent to providers
for more information.
September 17, 2015
In order to provide the most prompt response times to providers, all prior authorization requests must be faxed to MDwise.
For more information, see our Provider Prior Authorization Guide.
New Hoosier Care Connect Program
The Indiana Care Select
program ended on July 1, 2015. Hoosier Care Connect is a new coordinated care program for those who are age 65 and over; blind or disabled and living in the community, and are not eligible for Medicare. Children who are wards of the state and current and former foster children may also elect to enroll in the program. Hoosier Care Connect promotes preventive and comprehensive coordinated care. It addresses the physical, behavioral, medical and social needs of members. Members with chronic conditions such as asthma and diabetes will be enrolled in the MDwise INcontrol program. This program will help members understand their health conditions and increase engagement in their health care management. Learn more about the MDwise INcontrol program
. Members who need help in coordinating their health care will get personal case management and care coordination services.
If you have any questions about Hoosier Care Connect, please call MDwise customer service at 1-800-356-1204.
MDwise Launches MDwise Excel Network Delivery System
MDwise Excel Network will assume all provider contracts previously held by Hoosier Alliance. The change will take place on July 1, 2015. See the Provider Letter
sent to all MDwise providers.
Provider Helpline Hours Are Changing for Hoosier Healthwise & Healthy Indiana Plan (HIP)
Effective February 1, 2015, the MDwise Healthy Indiana Plan and Hoosier Healthwise plans are changing the provider services helpline hours. The provider helpline will be available from 8:00 a.m. to 8:00 p.m. Monday through Friday. We hope that by changing our hours, we are better able to serve you.
View archived news and announcements