Become an MDwise Provider
Please refer to the step-by-step instructions to assist you with enrolling in the MDwise network. Once you complete the applicable IHCP MCE Enrollment forms and compile the required documents, submit them to our MDwise Provider Enrollment via our online MProvider Connect tool. Account registration is required prior to submitting new enrollments or updates.
Additional options to submit enrollment forms include email, fax or mail, but the preferred option is through MProvider Connect.
Email: prenrollment@mdwise.org
Fax: 317-822-7310
Mail to:
MDwise Provider Enrollment
PO Box 441423
Indianapolis, IN 46244
If the submission is received by MDwise Provider Enrollment via MProvider Connect, the submitter will receive an automated email acknowledgment within one hour of submission with the submission tracking number. If the submission is received by MDwise Provider Enrollment via fax or mail, each submission is still assigned a tracking number that will be emailed back within five (5) business days of receipt.
Your provider type and specialty will determine the appropriate documents to complete and the specific instructions for completing them. Please refer to the MDwise Provider Participation Requirements and Documentation Requirements Table within the step-by-step instructions to identify the appropriate documents you must submit. In addition, all eligible provider types and specialties must be actively enrolled with the Indiana Health Coverage Programs (IHCP) and linked to the requested service location prior to submitting a network participation request to MDwise.
Once all applicable documents are submitted, MDwise will validate that the received information is complete. If an incomplete submission is identified, you will be notified within five (5) business days after receipt of initial request that an incomplete Provider Network Participation Request was received.
Provider Network Participation Forms
IHCP MCE Practitioner Enrollment Form
IHCP MCE Hospital/Ancillary Provider Enrollment Form
IHCP Provider Ownership and Managing Individual Maintenance Form