Provider type is based on the provider’s registration with the IHCP according to the
IHCP Specialty Matrix
Out-Of-State Provider
MDwise requires out-of-state providers to be certified, licensed, registered, or authorized as
required by the state in which the provider is located and must fulfill the same conditions as
an in-state provider. Please refer to the IHCP Provider Enrollment Type and Specialty
Matrix at which lists out-of-state
provider document requirements and which provider types, and specialties are ineligible for
out-of-state enrollment. For more information, see the Out-of-State Providers module
Common Issues Associated with network participation:
  • Not registering the providers location with IHCP prior to sending enrollment forms.
  • Not completing required forms.
  • Not completing all required fields on the forms.
  • Unsigned forms.
  • W-9 not signed and dated within the last 12 months.
  • Invalid state medical license or inappropriate professional license.
  • Missing explanation for work history gaps greater than six months.
  • Omission to disclose sanctions information on the CAQH enrollment form.
Providers should visit our website at for additional resource materials
and regular updates. In particular:
  • Provider Manual
  • Provider Portal
  • Claims Submission Information and Instructions
  • Successful Credentialing Criteria
  • Provider Network Participation
  • Frequently Asked Questions
  • ProTips