Prior Authorization Forms
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 MDwise Prior Authorization Reference and Contact Guide.
UPDATE on MDwise Medicaid Prior Authorizations
Prior authorization requests for Indiana Health Coverage Programs: Hoosier Healthwise and Healthy Indiana Plan
Forms
Prior Authorization Lists
Prior Authorization Form Archives
For pharmacy prior authorization forms, please visit our pharmacy forms page.