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important information

Medicaid eligibility review is underway for many MDwise members. Encourage patients to update their info with FSSA so they don’t lose their health coverage!

Info for patients

Billing and Claims

MDwise offers three distinct programs for Indiana residents: Hoosier Healthwise, Healthy Indiana Plan, and Medicare Advantage.

Hoosier Healthwise

hoosier healthwise insurance logo

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

Hoosier Healthwise Claims

Healthy Indiana Plan (HIP)

healthy indiana plan logo

A health plan for adults age 19 - 64.

Healthy Indiana Plan Claims

Medicare Advantage

MDwise Medicare Logo

 

All MDwise claims should be mailed to:
MDwise
P.O. Box 1575
Flint, MI 48501

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

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

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

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 the most up-to-date contact information for MDwise.

Claims Inquiry

Providers can access the myMDwise provider portal to quickly view the status of their claims. New users will need to request an account. Providers may also call our Provider Customer Service Unit at 1-833-654-9192.

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
Dispute Resolution 30 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 date of receipt.

MDwise providers must submit complete and accurate claims/encounter data as outlined in your MDwise contract. 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 about an EOB you received, please contact MDwise at 1-833-654-9192.