Healthy Indiana Plan (HIP) Provider Forms
Behavioral Health Forms
For behavioral health forms and resources, please visit the behavioral health area of our website.
MDwise Provider Forms 
HIP Full Panel Add Request
HIP Hold Panel Add Request
Member Intervention or Education Request
Prior Authorization Forms
MDwise Hoosier Alliance Prior Authorization
Prior Authorization Service List
MDwise Methodist Prior Authorization
MDwise St. Catherine
MDwise St. Catherine Family Planning
MDwise Hoosier Alliance DME Prior Authorization
MDwise Wishard NON DME Prior Authorization
MDwise Wishard DME Prior Authorization
Claims Forms
Claims Dispute Form NEW!
Billing Instructions for Claims
Billing Requirements for Pregnancy Services
Need Claims Info?
MDwise accepts claims in electronic format through several clearinghouses learn more...
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