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 and Healthy Indiana Plan. 

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

 

News and Announcements


May 30, 2018

 

Dear Providers,

MDwise Excel is aware that recently there has been a large number of incorrect denials on DME claims. The denial rejection is DME5. This rejection on the EOB states DME/PROSTHETICS REVIEW. PA REQUIRED IF TOTAL CLAIM > $500. Many of these claims are less than the $500 and therefore denying incorrectly. MDwise is working with Evolent on the system configuration to correct this denial error. Once the system configuration is complete, we will be pulling a list of claims that need reprocessed. If you have any questions or concerns, please reach out to Michelle Phillips, mphillips@mdwise.org.




May 11, 2018

 


MDwise claims vendor, Evolent Health, transitioned to a new mailroom process and solution effective July 1, 2018. The new mailroom solution is supported by Smart Data Solutions. 

Claims or documents originally sent to Corpus Christi, TX will now go to Eagan, MN. Please refer to our website for our up to date Provider Contact Guide.

Addresses are below by program:

MDwise Healthy Indiana Plan
P.O. Box 211571
Eagan, MN 55121


MDwise Hoosier Healthwise **excludes those Delivery Systems who bill to CMCS**
P.O. Box 211572
Eagan, MN 55121 

MDwise Hoosier Care Connect
P.O. Box 211512
Eagan, MN 55121

MDwise Marketplace
P.O. Box 211473
Eagan, MN 55121


Evolent Health set up mail forwarding with USPS to ensure all mail received at the current mailing address is automatically directed to the new mailroom location.

We recognize that there have been issues with returned provider mail and we apologize for any inconvenience. Evolent Health has a dedicated courier at the prior Corpus Christi, TX mailroom location who will check for provider mail daily. The courier will overnight any mail to the new mailroom location.

If you have additional questions about claim and correspondence mail, please contact our Provider Relations Department at 317-822-7300 ext. 5800.

Sincerely,
MDwise Provider Relations




May 11, 2018

 

MDwise has a tool to assist providers in coordinating Physical and Behavioral Health services. PMPs can register to use our Member Health Profile tool and view services that their members have received over the past 12 months.
 
This tool will allow you to see services including:

  • Specialist visits
  • Behavioral health
  • ER visits
  • Pharmacy activity 

Note: Services related to Substance Use Disorder and Infectious disease are excluded.

To register, please use the training guide. If you have any questions, please reach out to your MDwise delivery system provider relations representative.
 
Sincerely,
Ty Sullivan, MD, MBA
Chief Medical Officer

 

 




April 11, 2018

 

MDwise would like to remind providers of changes in the coverage of medications under the medical and pharmacy benefits for the MDwise HIP & HHW plans. These changes will be effective on June 1, 2018.

Information concerning the scheduled changes is as follows:

 

A prescription will be needed for these medications to enable claims processing through one of the contracted network pharmacies (AllianceRx Walgreens Prime, IU Health Retail, or Eskenazi Retail Pharmacies).
 
Providers are encouraged to reach out to their assigned MDwise provider relations representative for any questions or concerns. Alternatively, you may contact MDwise customer service at 1-800-356-1204 or send an email inquiry to pharmacy@mdwise.org.

We thank you for partnering with MDwise to provide quality care for our members.
 
 




March 9, 2018

 

The MDwise relationship with former claims vendor DST is coming to a close. All issues for claims with dates of service prior to 1/1/17 are due no later than 3/15/18. Per the MDwise Provider Manual:
 

  • Contracted providers have 90 days from the date of service to file a claim.
  • Non-contracted providers have 365 days from the date of service to file a claim.
  • Disputes are accepted up to 60 days from the date of the EOB.

 
All claims issues with dates of service prior to 1/1/17 that are received outside of the 60-day dispute timeframe, will not be considered for further review.
 




February 7, 2018

 

MDwise would like to announce changes in the coverage of medications under the medical and pharmacy benefits for the MDwise HIP & HHW plans. These changes will be effective on April 1, 2018 and June 1, 2018.

Information concerning the scheduled changes is as follows:
 


A prescription will be needed for these medications to enable claims processing through one of the contracted network pharmacies (AllianceRx Walgreens Prime, IU Health Retail, or Eskenazi Retail Pharmacies).
 

Providers are encouraged to reach out to their assigned MDwise provider relations representative for any questions or concerns. Alternatively, you may contact MDwise customer service at 1-800-356-1204 or send an email inquiry to pharmacy@mdwise.org.

We thank you for partnering with MDwise to provide quality care for our members.


 




January 31, 2018

 

We are excited to announce that MDwise Excel Network has partnered with Edgepark Medical Supplies to be our preferred provider for MDwise Excel Hoosier Healthwise and MDwise Excel Healthy Indiana Plan, effective February 1, 2018.

Edgepark has been a trusted provider for many years, offering fast and easy ordering of medical supplies delivered to the home. Advantages of the Edgepark Program include:

  • Fast, free shipping
  • ContinuCare™ order reminder program via phone and e-mail to encourage member compliance with their prescription
  • Orders arrive to your patients in 1 - 2 business days, after order processing
  • Dedicated Care team to take patients’ orders by phone Monday – Friday, 7 a.m. – 8 p.m. CST, and Saturday, 8 a.m. – 2 p.m. CST or online anytime at edgepark.com.


We are confident that these advantages, coupled with Edgepark’s ability to provide us with utilization reporting insights, will help us work together to improve member outcomes.

If your office needs to order supplies for our members, please call Edgepark at 1-866-528-0347 or send them an order using the physician’s order form located at MDwise.org. You will soon be receiving Detailed Written Orders (DWO) from Edgepark. Please review, sign, and return to Edgepark timely.
 




January 3, 2018

 

McLaren Health Care has completed its previously announced acquisition of MDwise. The acquisition establishes McLaren's first operations outside the state of Michigan, and grows the system's health plan assets to jointly serve more than 620,000 individuals, making it one of the region's largest provider-sponsored plans. MDwise will continue to operate under its current brand.
 

About McLaren

McLaren Health Care, headquartered in Grand Blanc, Michigan, is a fully integrated health network committed to quality, evidence-based patient care and cost efficiency. The McLaren system includes 13 hospitals, ambulatory surgery centers, imaging centers, a 490-member employed primary and specialty care physician network, commercial and Medicaid HMOs covering more than 620,000 lives in Michigan and Indiana, home health and hospice providers, retail medical equipment showrooms, pharmacy services, and a wholly owned medical malpractice insurance company. McLaren operates Michigan's largest network of cancer centers and providers, anchored by the Barbara Ann Karmanos Cancer Institute, one of only 49 NCI-designated comprehensive centers in the U.S. McLaren has 26,000 employees and more than 52,500 network providers. Its operations are housed in more than 350 facilities serving the entire Lower Peninsula along with a portion of the Upper Peninsula. Learn more at www.mclaren.org.




November 2, 2017


MDwise has agreed to be purchased by McLaren Health Care, a large Michigan-based health system that provides Medicaid benefits to over 260,000 Michigan residents through McLaren Health Plan.
 
This will require no changes on your part. The current provider network will remain in place, and you can continue to follow current protocols, processes and procedures.
 
MDwise will keep the same name and continue to participate in Hoosier Healthwise and Healthy Indiana Plan.
 
In addition, the change will not have any effect on a Member’s benefits.



July 18, 2017


MDwise Marketplace will cease participation in the Federal Health Insurance Exchange in 2018. Effective January 1, 2018 we will no longer offer MDwise Marketplace plans. Click here to read the full statement.



April 5, 2017

MDwise transitioned our claims payment vendor to Valence Health on January 1, 2017. MDwise realizes that a change in claims payment vendor may disrupt claims payment to providers during implementation, and we apologize that some of you have experienced this. We are taking all measures necessary to ensure providers receive accurate payments. Click here to view the provider notice.



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