Definitions
Enrollment – The process of loading a contracted and credentialed provider into MDwise internal systems, including loading for claims payment and loading to the provider directory (if applicable).
Credentialing – The process of reviewing the qualifications and appropriateness of a provider to join the MDwise network. The MDwise Credentialing requirements and processes follow NCQA guidelines.
Contracting/Negotiating – MDwise and the participating requester formally execute an agreement that outlines how the provider will deliver medical services, including reimbursement rates, scope of services and effective dates.
CAQH - The Council for Affordable Quality Healthcare
Missing/Incomplete Submission – All documentation must be sent with initial provider enrollment request. If any required documents are missing to process a provider network request, the submitter will be notified within five (5) business days of their submission. This notification will outline which documents are missing and allow the requestor to submit all missing documents within 24 hours. If all documents are not received within the allotted time, the case will be closed and provider will be required to submit a new case.
Complete Submission – If the Provider Relations Enrollment Team accepts all required forms and documentation, the provider will receive an acknowledgment and an enrollment ticket reference to begin the Credentialing, Contracting and Enrollment phase. New Contract Network Participation Requests will receive the MDwise Participation Agreement for review and signature while affiliated practitioners, providers or locations are credentialed.
Redlining – The process of highlighting areas within the agreement to request edits or receive clarification during the contracting process. Typically done through digital tools to track changes or comments. Helps to ensure all parties agree on the terms of the agreement.
Salesforce Case – Unique tracking number assigned to a provider enrollment submission or inquires.
Enrollment Status – Reflects the current state of a submitted enrollment case; status may include pending, closed, denied, etc.
MProvider Connect – MDwise online, self-service provider enrollment tool. Users can update provider enrollment information, submit inquires and/or forms to MDwise.
Online: MProvider Connect (preferred)
Email: prenrollment@mdwise.org
Fax: 317-822-7310
Mail: MDwise Provider Enrollment, PO Box 441423, Indianapolis, IN 46244
To receive a paper enrollment form, contact PR Enrollment at 317-822-7300 (and press 1 for Provider Enrollment).