• Billing and Claims

    MDwise offers two distinct programs for Indiana residents: Hoosier Healthwise and Healthy Indiana Plan.

    Hoosier Healthwise

    Hoosier Healthwise

    A health plan for children under the age of 19 and pregnant members.

    Hoosier Healthwise Claims

    Healthy Indiana Plan (HIP)

    HIP Healthy Indiana Plan

    A health plan for adults ages 19 - 64.

    Healthy Indiana Plan Claims

    All MDwise claims should be mailed to:
    MDwise
    PO Box 1575
    Flint, MI 48501

    Electronic Payer ID Numbers:
    Hoosier Healthwise EDI: 3519M
    Healthy Indiana Plan EDI: 3135M
    Medicare Advantage Plan EDI: MDADV

    Subrogation:
    If a member is involved in an accident, subrogation communication should be sent to:
    Multiplan
    Phone: 866-223-9974
    Fax: 866-297-3112
    Address:
    535 Diehl Road, Suite 100
    Naperville, IL, 60563

    Payment Policies

    Claims Forms

    MDwise has moved to Optum Clearinghouse. If you are already enrolled with Optum for other payers, there is nothing else you need to do; Optum will add MDwise to your profile.

    Taxonomy Code Requirements (PDF)

    Please be aware that in-network providers have 90 days from the date of service to submit claims. Further information on claim submission and guidelines can be found in the Provider Manual.

    MDwise Quick Contact Guide (PDF) provides MDwise with the most up-to-date contact information.

    Claims Inquiry

    Providers can access the myMDwise provider portal to view their claims quickly. New users will need to request an account. Providers may also call our Provider Customer Service Unit at 833-654-9192.

    Disputing Claims

    Providers have 90 days from the initial claim determination to submit a dispute.

     

    Claim Timelines

    Claim Submission Type Submission Deadline (calendar days)
    MDwise Contracted Providers 90 days from the date of service
    Non-Contracted Providers 180 days from the date of service
    Secondary Claims 90 days from the date of the primary EOB
    Claim Adjustments 60 days from the date of EOB
    Claim Dispute 90 days from the date of EOB
    Newborn Claims 365 days from the date of service within the first 30 days of life
    Adjudication Response Time
    Clean Electronic Claim 21 business days from the date of receipt
    Clean Paper Claim 30 business days from the date of receipt
    Informal Dispute Resolution 30 calendar days from the date of receipt
    Formal Dispute Resolution 45 calendar days from the date of receipt

    According to 42 CFR § 447.45, the Centers for Medicare & Medicaid Services (CMS) define a clean claim as one submitted by a provider for payment and processed without obtaining additional information from the provider of service or a third party. The receipt date of a claim is the date that MDwise receives either written or electronic notice of the claim. All hard-copy claims are stamped with the date of receipt.

    MDwise providers must submit complete and accurate claims/encounter data as your MDwise contract outlines. If a member has other health coverage, the provider submits a corresponding claim or encounter data for every service provided, with claim detail identical to that required for fee-for-service claims submissions. Providers are encouraged to submit claims electronically as this helps to ensure more timely processing.

    Questions about Claims: If you have a question about a specific claim submitted or an EOB you received, please contact MDwise at 833-654-9192.