Primary Medical Provider Network Participation Requirements

Primary Medical Provider (PMP)
MDwise works to have a quality network of providers for its members to choose from. This document outlines the requirements that providers must meet before they can accept a panel as a MDwise Primary Medical Provider (PMP).
 
Specific PMP Duties
The Primary Medical Provider (PMP) is an integral part of the MDwise managed health care program. The PMP functions as the central access point for MDwise members. MDwise PMP’s coordinate all covered service for their assigned members, except for self-referral and carved- out services. This includes guiding members to participating specialists and hospitals when necessary and maintaining continuity of each member’s health care.
Each PMP who participates with MDwise must agree to the following participation requirements:
 
Policies and Procedures
  • Follow all MDwise policies and procedures in addition to all Federal and State
requirements for the Hoosier Healthwise (HHW), Healthy Indiana Plan (HIP)
  • MDwise policies are described in the Provider Manual.
 
If you have any questions about these policies, call your provider relations representative or call MDwise Customer Service at 1-800-356-1204.
 
IHCP Enrollment
  • If applicable, must be enrolled with the State as a participating provider in the Indiana Health Care Programs (IHCP). This means having a valid, current Medicaid provider number.
 
Panel Size
Accept and maintain a member panel, based on the participating program.
  • Hoosier Healthwise: 150-2000 members
  • Healthy Indiana Plan: 125-2000 members