Taxonomy Code Requirements
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 provides MDwise with the most up-to-date contact information.
Claims Inquiry
Providers can access the myMDwise provider portal to view the status of 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 |
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| 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.