Effective Date Policy

All network participation requests must follow the following network effective date policy for all
provider types and for all delegated provider networks.
 
POLICY:
Providers will be effective with MDwise either on the first of the month following the receipt of a complete network participation request or the first of the month following the contract execution for brand new providers per the additional guidance below: 
  • For brand-new providers requesting to join the network, once MDwise has received the complete network participation request electronically via an online portal, email, postal mail, or fax and all required fields, supporting documentation provided and signed, the effective date will be the first of the month following the contract execution.  
  • A provider that is being added to an existing contract will be effective the first of the month following receipt of the network participation request from the provider. The network participation receipt date is the date MDwise receives the provider’s complete network participation request electronically via an online portal, email, postal mail, or fax. All required fields must be completed, required supporting documentation provided, etc. for the network participation request to be considered complete.
  • NOTE: the effective date policy does not affect delegated provider arrangements.

PROCEDURE:
  • The same effective date policy will be in place regardless of whether the network participation request is for a hospital/ancillary provider or a practitioner.
  • MDwise network effective date will also be after the IHCP effective date. Note: Providers must be enrolled and effective with IHCP prior to being effective with MDwise.
  • All required fields must be completed, required supporting documentation provided, etc. for the network participation request to be considered complete.
  • To be able to render services, the contract or contract amendment must be executed by both parties.
  • Providers should hold all claims until the final welcome letter from the MDwise is received confirming that they are effective with the MDwise network.
  • Providers are expected to complete all pieces of the network participation process timely. However, in instances where the network participation process extends for a-time period longer than the standard timeframe, MDwise will not hold providers to the timely filing limit for claims rendered before the provider was confirmed effective.
  • The effective date will be the first of the month following the receipt of a complete network participation request or the first of the month following the contract execution for brand new providers, regardless of credentialing completion date. In most cases, the effective date will be retroactive back to the first of the month following receipt of the complete network participation request or the first of the month following the contract execution for brand new providers since providers will not be fully effective until they are credentialed and have a signed contract or contract amendment with the MDwise.
    • If a provider is unable to be credentialed with the MDwise, the provider will not be effective with the MDwise.
    • If MDwise and provider cannot come to terms with a contract, the provider will not be effective with the MDwise.

Exceptions to Effective Date
  • MDwise may allow for retroactive effective dates in situations such as the following:
    • When the retroactive date is in the best interest of member care.
    • In situations involving changes of ownership, including provider mergers, acquisitions, or tax identification changes. 
    • In situations where a provider has a pre-existing contractual relationship with MDwise and has sought a change in their provider enrollment type or classification with the IHCP (i.e., when a provider was enrolled as a Billing provider but has decided to enroll as a Group provider).
    • Upon request from federally qualified health centers (FQHCs) or rural health clinics (RHCs).
    • An effective date may not be backdated prior to the date enrolled with IHCP.