Prior Authorization Forms

MDwise Medicaid Prior Authorization Process

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 or the MDwise Prior Authorization quick reference guide.

You can also view our comprehensive Prior Authorization quick contact guide that includes delivery system PA contact information for Hoosier Healthwise and Healthy Indiana Plan.

UPDATE on MDwise Medicaid Prior Authorizations

Prior authorization requests for Indiana Health Coverage Programs: Hoosier Healthwise and Healthy Indiana Plan

MDwise delivery system contact information for Hoosier Healthwise and HIP prior authorizations.

Hoosier Healthwise


Healthy Indiana Plan


MDwise Marketplace


For pharmacy prior authorization forms, please visit our pharmacy forms page.