Healthy Indiana Plan (HIP) Provider Forms
Behavioral Health Forms
Behavioral Health Referral Form
Help Guide, When to Refer a Behavioral Health Provider
For behavioral health forms and resources, please visit the behavioral health area of our website.
MDwise Provider Forms 
HHW/HIP Full Panel Add and Hold Panel Add Request NEW!
Member Intervention or Education Request
MCE Universal Provider Enrollment Form
Download the Universal Credentialing Form
Prior Authorization Forms
Universal PA Form
Prior Authorization Service List
MDwise St. Catherine, Family Planning
Claims Forms
HIP Claims Provider Inquiry Form
Claims Dispute Form PDF | Word
Billing Instructions for Claims
Billing Requirements for Pregnancy Services
Need Claims Info?
MDwise accepts claims in electronic format through several clearinghouses learn more...
Accessibility