Claims Forms

MDwise is moving to Optum Clearinghouse for 2019. To receive electronic payments for 2019 dates of service you need to enroll with Optum. If you are already enrolled with Optum for other payers, there is nothing else you need to do, Optum will add MDwise to your profile.
  • Providers will go through Optum to sign up
  • Can begin signing up 11/1/18 for 2019 dates of service
  • Optum: www.optum.com/eps
 
 **For Hoosier Healthwise member claims disputes, please review the "Claims Dispute Process" document above before submitting your form. 

Archived Claims Forms