MDwise

MDwise Medicaid Prior Authorization Process

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

For more information, see our MDwise Prior Authorization Reference and Contact Guide.
 

Forms

• Portal Instructions 
• Universal PA Form for Hoosier Healthwise and HIP

• Prior Authorization Reference Guide for Hoosier Healthwise and Healthy Indiana Plan

• Behavioral Health Forms

Prior Authorization Lists

• 2020 Maternity Code Exemption List 
• Prior Authorization and Exclusion Lists for Hoosier Healthwise and HIP Effective 4/1/2022 - NEW! - Archived v. 3/1/22
• 2021 Searchable Behavioral Health Services that Require Prior Authorization for Hoosier Healthwise and HIP

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