Frequently Asked Questions

Frequently Asked Questions

1. How do I join MDwise Provider Network?

To join the MDwise Provider Network, the provider, the group, or organization if applicable, must first be enrolled with IHCP. You must then Complete the appropriate MDwise Provider Network Participation Request Forms. Please determine the form appropriate for your provider type and specialty:

IHCP MCE Practitioner Enrollment Form
IHCP MCE Hospital/Ancillary Provider Enrollment Form

2. Which Provider Network Participation Request Forms should I select?

  • Individual practitioners and/or group practices. If you are an individual provider or a group of providers who perform medical services, please complete, and submit the IHCP MCE Practitioner Enrollment Form.
    • Group practices must fill out one Provider Network Participation Form for the group and an entry for each licensed practitioner in the group.
  • Hospital/Ancillary or Facility providers. If you are enrolled by the IHCP to provide services as a facility or an organization (this includes Durable Medical Equipment (DME) providers), please complete and submit the IHCP MCE Hospital/Ancillary Provider Enrollment Form.
    • Complete the Organization Enrollment Form for the primary site and an entry for each additional service location.

3. What will the Provider Network Participation Enrollment process include?

The enrollment process includes:

  • Provider Network Participation Request Form — MDwise will confirm you have fully completed the enrollment form and supplied all required supporting documents. You will receive an automated message within five (5) business days of receipt and an enrollment tracking reference number.
  • Verification of credentials — MDwise verifies information including, but not limited to, license status, insurance coverage, and education/training using criteria defined to meet accreditation, regulatory and other applicable requirements.
  • Assign Effective Date — If your credentials meet the required standards, the submitted information is sent to the MDwise credentialing committee to review and in accordance with applicable IN state laws. If approved, an effective date per effective date policy will be assigned to the contract/agreement, for the first of the month the complete submission was received or the first of the month following the contract execution for brand new providers.

4. What are the provider classification types and specialties?

As an MDwise provider, you may fall into one of the following three classifications for claim submission and reimbursement purposes:

  • Billing Provider - A practitioner operating as an individual or sole proprietor, or an organization operating as a business entity, billing for services at a distinct service location, with no rendering providers linked to the practice or entity
  • Group Provider - A practice or business entity operating at a distinct service location with one or more practitioners or rendering providers linked to a common taxpayer identification number (TIN) for billing
  • Rendering Provider - A practitioner or other provider rendering services for a group practice and linked to a common TIN.
    • A provider enrolled as a rendering provider under one or more groups at one or more service locations may also enroll as a billing provider at a different service location.

5. What documents are required and included in the Provider Network Participation process?

Refer to below for documentation requirements. Each document is required as applicable per provider type and specialty.

Practitioner Participation Document Requirements

  • IHCP MCE Practitioner Enrollment Form
  • **Collaborative/Supervisory Agreement (required if applicable)
  • **Required for Advanced Practice Nurse (Nurse Practitioner, Clinical Nurse Specialist, Certified Nurse Midwife), and Physician Assistant
  • CAQH Proview Online Application (If not currently enrolled)
  • MDwise requires the CAQH number be submitted on the IHCP MCE Practitioner Enrollment Form to initiate the credentialing process.
  • Please ensure the following requirements are addressed in your CAQH Proview Online Application (CAQH Application):
    • All current licenses and an active license to practice in Indiana must be detailed in the “Professional ID” section of the CAQH Application
    • (Page 35 of User Guide)
    • Details of your current DEA or CDS certificate, as applicable, must be entered for each state where services are provided in the “Professional ID” section of the CAQH Application (Page 35 of the User Guide), and a copy uploaded in the “Uploading Documents” section of the CAQH Application
    • Education/Training details must be completed as appropriate to specialty(ies) (Page 37 of the User Guide)
    • All current, Indiana-based hospital affiliations must be detailed in the Hospital Affiliations section (Page 84 of the User Guide)
    • Current Professional Liability Insurance (Malpractice Insurance Coverage) details must be entered in the “Professional Liability Insurance” section of the CAQH Application (Page 102 of the User Guide)
    • Most recent five-years’ work history, in month/year format (employment gaps greater than 6 months explained), must be detailed in the “Employment Information” section of the CAQH Application (Page 117 of the User Guide)
    • Provide a narrative explanation to any question answered as “Yes” in the “Disclosure” section of the CAQH Application (Page 124 of the User Guide)
    • Select in the “Authorize” section of the online application the option that reads: “All health care organizations who indicate I am an affiliated provider or am in the process of becoming an affiliated provider.” Otherwise, you may choose us individually by clicking the second option and then selecting MDwise in the table below the choice. If MDwise cannot retrieve your application, this could delay approval. All details for completing this section of the CAQH application may be found on Page 125 of the CAQH Proview Provider User Guide.
    • Ensure attestation to the completeness and accuracy of the CAQH application in the “Review and Attest” section that follows (Page 127 of the CAQH Proview Provider User Guide) within 120 days prior to submission of participation request to MDwise. Otherwise, your attestation may have expired upon credentialing and this could delay your approval.
  • Form W-9 (required if applicable)
    (required to be signed within the last 12 months)
  • Disclosure Ownership and Interest Form

Hospital/Ancillary Participation Document Requirements

  • IHCP MCE Hospital/Ancillary Provider Enrollment Form
  • Form W-9 (required if applicable)
    (required to be signed within the last 12 months)
  • State License
  • CMS site evaluation ‒ If state site survey is not available
  • Indiana Department of Health Accreditation Certificate with site survey
  • Copy of Medicare certification letter (Universal Form)
  • Copy of Medicaid certification letter
  • Liability coverage face sheet
  • Clinical Laboratory Improvement Amendments (CLIA) Certificate
    (required if applicable)
  • Drug Enforcement Agency (DEA) Number
    (required if applicable)

6. Does the enrollment and credentialing timeline continue if I need to re-sign or resubmit a document?

No, all documentation must be sent in with the Provider Network Participation Request Form and be complete. If there are missing documents required to process a provider network participation request, the provider will be notified within five (5) business days of submission. The network participation enrollment ticket will be closed with direction on resubmission within 5 business days of submission.

7. How long does provider credentialing take?

The credentialing process can take up to 30 days from submission for a clean file. To ensure the process is not delayed, please verify that MDwise is listed as an ‘authorized’ health plan to access CAQH applications during the credentialing process. Credentialing may take longer if additional information is needed to complete a credentialing file review following State, Federal, MDwise, and NCQA guidelines.

8. Can I submit claims prior to receiving the welcome letter and or effective date?

Providers should hold all claims until the final welcome letter from MDwise is received confirming that they are effective with the MDwise network. MDwise and providers are expected to complete all pieces of the network participation process timely. However, in instances where the network participation process extends for a period longer than the standard timeframe at fault of the health plan, MDwise will not hold providers to the timely filing limit for claims rendered before the provider was confirmed effective.