Prior Authorization

Prior Authorization

MDwise Medicaid prior authorization requirements are applicable to the following services:

• Behavioral Health Services
• Medical Services
• Medications (‘Buy and Bill’ HCPCS Codes) billed under the medical benefit

Resources

• Authorization Portal Instructions (PDF)
• Appendix A SPC Code Set (PDF)
• Prior Authorization Reference Guide for Hoosier Healthwise and Health Indiana Plan (PDF)
• Prior Authorization Appeal Request Form (PDF)
• Universal Prior Authorization Form (PDF)
• Residential/Inpatient Substance Use Disorder Treatment Prior Authorization Request Form (PDF)

Prior Authorization Lists

Behavioral Health Services

• Hoosier Healthwise and Healthy Indiana Plan Behavioral Health Authorization and Exclusion List Effective 7/1/2025 (PDF)
• Hoosier Healthwise and Healthy Indiana Plan Behavioral Health Services that Require Prior Authorization and Exclusion List Effective 10/1/2024 (PDF)

Medical Services

• Hoosier Healthwise and Healthy Indiana Plan Medical Services that Require Authorization and Exclusion List Effective 8/1/2025 (PDF)
• Hoosier Healthwise and Healthy Indiana Plan Medical Services that Require Prior Authorization effective 5/1/25 (PDF)
• Hoosier Healthwise and Healthy Indiana Plan Medical Services that Require Prior Authorization and Exclusion List effective 10/1/2024 (PDF)
• The Medical Prior Authorization and Exclusion Lists for Hoosier Healthwise and HIP effective 10/1/23 (PDF)
• The Medical Prior Authorization and Exclusion Lists for Hoosier Healthwise and HIP effective 1/1/23 (PDF)

Medications (‘Buy and Bill’ HCPCS Codes) under the medical benefit

• Hoosier Healthwise and Healthy Indiana Plan Medications (HCPCS Codes) Prior Authorization and Exclusion List effective 8/1/25 (PDF)
• Hoosier Healthwise and Healthy Indiana Plan Medications (HCPCS Codes) Prior Authorization and Exclusion List effective 10/1/24 (PDF)

Contact Information for PA Submissions*

PA Inquiry Phone Numbers

MDwise Excel Hoosier Healthwise (HHW):  888-961-3100
MDwise Excel Healthy Indiana Plan (HIP):  888-961-3100

PA Fax Submissions

HHW: 888-465-5581
HIP Fax for Inpatient: 866-613-1631
HIP Fax for Outpatient: 866-613-1642

Email: padept@mdwise.org

Portal Login

*Please visit Pharmacy Resources | MDwise for contact information and PA requirements related to medications billed under the pharmacy benefit.