Become a Provider & Provider Network Participation

Provider Network Participation

 
Thank you for your interest to participate in our network. Before proceeding, please review the “How to enroll with MDwise” section below. The How to Enroll section offers information for providers interested in participating in the MDwise Provider Network.
 

How to Enroll with MDwise

 
Please refer to the step-by-step instructions to assist you with enrolling in the MDwise network. Once you complete the applicable IHCP MCE Enrollment forms and compile the required documents, submit them either to MDwise Provider Enrollment at prenrollment@mdwise.org, or via fax at 317-822-7310. Providers also have the option of submitting paper request via mail to:
MDwise Provider Enrollment
PO Box 441423
Indianapolis, IN 46244

If the submission is received by MDwise Provider Enrollment at prenrollment@mdwise.org, the submitter will receive an automated email acknowledgment within one hour of submission with the submission tracking number. If the submission is received by MDwise Provider Enrollment via fax or mail, each submission is still assigned a tracking number that will be faxed or mailed back within five (5) business days of receipt.
 
Your provider type and specialty will determine the appropriate documents to complete and the specific instructions for completing them. Please refer to the MDwise Provider Participation Requirements and Documentation Requirements Table within the step-by-step instructions to identify the appropriate documents you must submit. In addition, all eligible provider types and specialties must be actively enrolled with the Indiana Health Coverage Programs (IHCP) and linked to the requested service location prior to submitting a network participation request to MDwise.
 
Once all applicable documents are submitted, MDwise will validate that the received information is complete. If an incomplete submission is identified, you will be notified within five (5) business days after receipt of initial request that an incomplete Provider Network Participation Request was received.
 
Provider Network Participation Forms
IHCP MCE Practitioner Enrollment Form
IHCP MCE Hospital/Ancillary Provider Enrollment Form
IHCP Provider Ownership and Managing Individual Maintenance Form