MDwise
Provider Link Newsletter

Just a reminder that providers have 365 days to bill newborn claims for the first 30 days of life. This extended timeframe is to allow time for the newborn to be assigned a member identification number (MID), and for providers to be able to bill claims using that MID. Newborn claims should never be billed using the mother’s MID. Also, be sure to bill the newborn claims using the correct member birthweight diagnosis. Failure to bill with the correct MID or diagnosis could result in a denied or rejected c...

It is important to remember, except for a very few exceptions, a Medicaid member cannot be billed for health care services. Please review the MDwise provider manual for these exceptions and the criteria you must meet before billing a member. If a provider has received payment on a Medicaid claim, the member may never be asked to pay an additional amount, or be balance-billed, for that claim. When cost-sharing is no longer suspended, providers may bill a Healthy Indiana Plan (HIP) member for a co-pay if ...

In our ongoing commitment to advancing healthcare quality and access for all, we want to emphasize the critical role of the National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care (CLAS). These standards are instrumental in promoting health equity and ensuring that everyone, regardless of their background, receives the care they need and deserve.  The CLAS standards were developed by the U.S. Department of Health and Human Services (HHS) to help healthcar...

Access to healthcare is essential, and having reliable transportation to medical appointments is a critical part of that access. MDwise offers transportation services for eligible members under the HIP State Plan Plus and HIP State Plan Basic, ensuring you can reach your doctor’s appointments smoothly. Transportation services are designed to assist when no other means of getting to an appointment are available. Eligibility for Transportation Services Transportation services are available to all MDwise m...

Together with its Pharmacy Benefits Manager (PBM), MedImpact, MDwise provides physicians and other health care providers services to assist with the process of prescribing drug therapy for their patients. Prescribers have access to patient-specific prescription eligibility, medication history, and basic formulary information for consenting patients in both inpatient and outpatient settings. This exchange of essential intelligence between prescribers and the MDwise PBM enables physicians to write an info...

MDwise works to continuously improve our tools and resources for our providers. Most recently, we added a feature to the MProvider Connect enrollment tool allowing users to pull provider rosters. If you already have an account, simply log in and on the main home screen you’ll see the new “Pull Rosters” button next to your provider group name. This self-service feature allows our provider partners to verify we have the most up to date provider information loaded into our systems. If there is a discrepanc...

Contracted MDwise providers are assigned a dedicated provider representative. Your provider representative is here for you to answer general MDwise questions and help guide you through our processes and procedures. If you have not yet met your provider representative or do not know who that is, please visit our website to find the most up to date territory map. You can find your dedicated rep’s contact information here .

MDwise would like to express our sincere gratitude for your continued dedication to our members and your pivotal role in our health plan network. Your commitment to delivering exceptional care is greatly appreciated. As part of our ongoing efforts to enhance our services and support, we have developed a brief survey that we kindly ask you to complete. Your feedback is crucial to us; it will help us understand how well we are meeting your needs and identify areas where we can improve our business operati...