MDwise

MDwise Medicaid Prior Authorization Process

In order to provide the most prompt response times to providers, all prior authorization requests must be faxed to MDwise.

For more information, see our Provider Prior Authorization Guide or the MDwise Prior Authorization quick reference guide.

You can also view our comprehensive Prior Authorization quick contact guide that includes delivery system PA contact information for Hoosier Healthwise and Healthy Indiana Plan.
 

UPDATE on MDwise Medicaid Prior Authorizations

Prior authorization requests for Indiana Health Coverage Programs: Hoosier Healthwise and Healthy Indiana Plan
 

MDwise delivery system contact information for Hoosier Healthwise and HIP prior authorizations.

Important Medical Billing Information

• Medical Code Exclusion List
• Self-Administered Codes for Medical

Forms

• Universal PA Form for Hoosier Healthwise and HIP

Hoosier Healthwise

Current Prior Authorization Lists

• MDwise St. Catherine Referral/PA Form for Hoosier Healthwise, Family Planning
• MDwise Eskenazi Health Prior Authorization Quick Reference Guide for Hoosier Healthwise
• 2018 MDwise Excel Network Prior Authorization List for Hoosier Healthwise
• 2018 MDwise Excel Network Searchable Prior Authorization List for Hoosier Healthwise
• *Effective 4/1/2018 – 2018 MDwise Excel Network Prior Authorization List for Hoosier Healthwise
• *Effective 4/1/2018 – 2018 MDwise Excel Network Searchable Prior Authorization List for Hoosier Healthwise
• *Effective 6/1/2018 – 2018 MDwise Excel Network Prior Authorization List for Hoosier Healthwise
• *Effective 6/1/2018 – 2018 MDwise Excel Network Searchable Prior Authorization List for Hoosier Healthwise
• *Effective 7/1/2018 - 2018 MDwise Excel Network Prior Authorization List for Hoosier Healthwise
• *Effective 7/1/2018 - 2018 MDwise Excel Network Searchable Prior Authorization List for Hoosier Healthwise
• Behavioral Health Services that Require Prior Authorization for Hoosier Healthwise
• Searchable List of Behavioral Health Services that Require Prior Authorization for Hoosier Healthwise
• MDwise Indiana University Health Prior Authorization Quick Reference Guide for Hoosier Healthwise
• MDwise Select Health Network Prior Authorization List for Hoosier Healthwise
• MDwise St. Catherine Prior Authorization Quick Reference Guide for Hoosier Healthwise
• MDwise St. Vincent Prior Authorization List for Hoosier Healthwise
• MDwise Total Health Prior Authorization List for Hoosier Healthwise
• MDwise Community Health Network Prior Authorization List for Hoosier Healthwise

• 2017 MDwise Excel Network Prior Authorization List for Hoosier Healthwise
• 2017 MDwise Excel Network Searchable Prior Authorization List for Hoosier Healthwise

• 2016 MDwise Excel Network Prior Authorization List for Hoosier Healthwise
• 2016 MDwise Excel Network Searchable Prior Authorization List for Hoosier Healthwise
• For dates prior to 8/28/17: 2017 MDwise Excel Network Prior Authorization List for Hoosier Healthwise
• For dates prior to 8/28/17: ​2017 MDwise Excel Network Searchable Prior Authorization List for Hoosier Healthwise

Healthy Indiana Plan

• 2018 HIP Medical Services that Require Prior Authorization
• 2018 Searchable List of HIP Medical Services that Require Prior Authorization
• *Effective 4/1/2018 – 2018 HIP Medical Services that require Prior Authorization
• *Effective 4/1/2018 – 2018 Searchable List of HIP Medical Services that Require Prior Authorization
• *Effective 6/1/2018 – 2018 HIP Medical Services that Require Prior Authorization
• *Effective 6/1/2018 – ​2018 Searchable List of HIP Medical Services that Require Prior Authorization
• *Effective 7/1/2018 - 2018 HIP Medical Services that Require Prior Authorization
• *Effective 7/1/2018 - 2018 Searchable List of HIP Medical Services that Require Prior Authorization
• HIP Behavioral Health Services that Require Prior Authorization
• Searchable List of Behavioral Health Services that Require Prior Authorization for HIP
• Universal PA Form for Hoosier Healthwise and HIP

• 2017 HIP Medical Services that Require Prior Authorization
• 2017 Searchable List of HIP Medical Services that Require Prior Authorization

• 2016 HIP Medical Services that Require Prior Authorization
• 2016 Searchable List of HIP Medical Services that Require Prior Authorization
• For dates prior to 8/28/17: 2017 HIP Medical Services that Require Prior Authorization
• For dates prior to 8/28/17: Searchable List of 2017 HIP Medical Services that Require Prior Authorization

For pharmacy prior authorization forms, please visit our pharmacy forms page.