Skip navigation

MDwise

NewsroomCareersContact Us
  • Home
  • For Members
    • Hoosier Healthwise
    • Healthy Indiana Plan
  • For Providers
    • Manual and Overview
    • Behavioral Health
    • Care Management
    • Pharmacy Resources
    • Physician Pay For Value
    • Tools and Resources
    • Forms
    • Quality
    • Claims
    • Continuing Education
    • myMDwise Provider Portal
    • ProviderLink Newsletter
    • Contact Information
  • Become a Member
    • Apply for Hoosier Healthwise
    • Apply for Healthy Indiana Plan
  • Events
    • Events Calendar
    • Partners
  • About Us
    • Who We Are
    • Our Health Plans
    • MDwise Leadership
    • Media Center
  • Manual and Overview
  • Behavioral Health
  • Care Management
  • Pharmacy Resources
  • Physician Pay For Value
  • Tools and Resources
  • Forms
    • Behavioral Health Forms
    • Care Management Forms
    • Claims Forms
    • Member Management Forms
    • Pharmacy Forms
    • Prior Authorization Forms
      • Prior Authorization Forms Archives
    • Provider Enrollment Forms
  • Quality
  • Claims
  • Continuing Education
  • myMDwise Provider Portal
  • ProviderLink Newsletter
  • Contact Information

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

  • 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 - NEW!
  • Medical Prior Authorization and Exclusion Lists for Hoosier Healthwise and HIP - NEW!
  • 2021 Searchable Behavioral Health Services that Require Prior Authorization for Hoosier Healthwise and HIP

Prior Authorization Form Archives
 

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

Connect with us Facebook Twitter Instagram
  • Contact Us
  • Careers
  • Site Map
  • HIPAA Policy
  • Privacy Policy
  • Terms of Use
  • Print This Page
  • Email this Page

Page updated 03/08/2021 | Copyright © 2007-2021 MDwise, Inc. All Rights Reserved

.