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 includes contact information for Hoosier Healthwise and Healthy Indiana Plan. 

View our comprehensive Prior Authorization Reference Guide that includes PA contact information for Hoosier Healthwise and Healthy Indiana Plan.

 

News and Announcements


August 27, 2021


Recently updated Medical Prior Authorization and Exclusion Lists for Hoosier Healthwise and HIP are now available on the MDwise website. The lists are effective October 1, 2021 and can be found here https://www.mdwise.org/for-providers/forms/prior-authorization.  
 
As of October 1, 2021, MDwise will allow coverage of the following medications under the medical benefit with prior authorization required.
Cinqair (reslizumab)
Fasenra (benralizumab)
Nucala (mepolizumab)
Xolair (omalizumab)
Prolia (denosumab)
Reclast (zoledronic acid)
Xgeva (denosumab)
Zometa (zoledronic acid)
Avsola (infliximab-axxq)
Inflectra (infliximab-dyyb)
Renflexis (infliximab-abda)
 
Although coverage at the pharmacy will continue, providers now have the option to procure the medication and submit claims to MDwise under the medical benefit (“buy and bill”). Please note that these medications will require prior authorization (PA) before medical claims will be considered for payment. A medical benefit PA is required even if the patient already has an approved PA under the pharmacy benefit.
 
All medical PA requests should be submitted using the Indiana Health Coverage Programs (IHCP) Universal Prior Authorization Form. Prior Authorization requests can be submitted via fax, email, or via our Authorization Portal.
Fax MDwise Hoosier Healthwise (HHW) Excel: 1-888-465-5581
Fax MDwise Healthy Indiana Plan (HIP) Excel: 1-866-613-1642
Email: padept@mdwise.org
Portal https://mdwisepp.zeomega.com/cms/ProviderPortal/Controller/providerLogin



June 15, 2021


A helpful guide for setting up a provider account in the authorization portal is now available here under Forms.



June 3, 2021


As of July 1st, MDwise strongly encourages Providers to submit Claims electronically. Electronic Claim submission provides significant benefits to the Provider including:
  • Helps reduce operation costs associated with paper Claims (printing, postage, etc.).
  • Increases accuracy of data and efficient information delivery.
  • Reduces Claim delays since errors can be corrected and resubmitted electronically.
  • Track and monitor claim progress.
  • Expedite a processing turnaround and potential payment time frames
  • Fastest way for Clean Claims to be considered for reimbursement.
 
MDwise accepts EDI transactions through our clearing house for Claims via the 837P for Professional and 837I for Institutional.
 
Submit Claims to MDwise via your EDI clearing house using the correct Payer ID:
  • Hoosier Healthwise (HHW) EDI: 3519M
  • Healthy Indiana Plan (HIP) EDI: 3135M
 
Dental claims for MDwise members should be submitted to DentaQuest using Payer ID CX014 for HHW and HIP.
 
A member’s benefit plan and eligibility can be identified through the myMDwise Provider Portal at mdwise.org.
 
Please contact the MDwise Claims department at 833-654-9192 or your assigned Provider Relations Representative found at mdwise.org for any questions.
 
Thank you for being a valued Provider and serving our members!



January 28, 2021


Back in August 2020, MDwise notified all providers that all claims would be subject to Optum CES edits beginning October 1, 2020.  Some of those edits were not initially functional.   All remaining validation edits will be implemented on March 1st, 2021.      
 
All claims submitted to MDwise will be subject to Optum CES. CES is designed to automatically check each claim, on a pre-payment basis, for errors, omissions and questionable coding relationships by testing the data against industry rules, regulations and policies governing health care claims. CES will also detect coding errors, including but not limited to: errors relating to unbundling, incidental procedures, modifier appropriateness, diagnoses and duplicate claims.

Sources used by Optum CES for edits include, but are not limited to, the following:
  • National Correct Coding Initiative (NCCI) edits, including Medically Unlikely Edits (MUEs) Federal Register (the Daily Journal of the US Government that contains agency rules, proposed rules and public notices)
  •  Medicare publications
  • Local and National Coverage Determinations (LCDs/NCDs) Outpatient Code Editor (OCE)
  • Medicare Code Editor (MCE)

What do you need to do?
Since many other carriers with whom you work already use Optum CES, we do not anticipate this implementation will disrupt how you work with MDwise. CES will replace our legacy edits and automatically review and catch errors, omissions and questionable coding. The end result will be streamlined claims, reduced reimbursement errors and improved payment integrity. All edits are transparent, and you will be able to look up specific claims and see both the edits and the sourced citations.

Claims will be reviewed through CES and if a claim is denied, it will show on your payment file or EOP.



   January 26, 2021 


As of January 25, 2021, Hoosiers aged 70 and up, along with long-term care residents, first responders, and healthcare workers who have in person contact are eligible to receive the COVID-19 vaccine.  As more vaccines become available, we will provide up to date information for our providers or you may visit ourshot.in.gov to see who is eligible or sign up to receive the vaccine.



January 13, 2021


The Provider Workforce Capacity Survey:  FSSA Needs Your Help!

Who:  Indiana Healthcare Providers

What:  Brief (approximately 15 – 20 minutes), online survey

When: Access your survey no later than February 5, 2021.

Why:  This important survey will provide information specific to the workforce supply for patients with substance use disorder (SUD).  Findings from this survey will inform State planning activities to expand substance use treatment services. 

How:  To access your survey, select the link below or copy and paste the URL into your internet browser:
https://fssain.iad1.qualtrics.com/jfe/form/SV_e9VPgfeJgVcxtXv
Please reach out to the survey team at FSSASUD@fssa.IN.gov, should you have any questions or concerns related to this survey.  

Thank you in advance for sharing your input.
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This provider survey is supported by the Centers for Medicare and Medicaid Services (CMS) of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $2,760,638.00 with 100 percent funded by CMS/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by CMS/HHS, or the U.S. Government.

This provider survey is one component of a statewide needs assessment to identify policies, education, and technical assistance designed to increase the capacity of providers in Indiana to offer treatment for substance use disorder.

View archived news and announcements

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