Quick Contact Guide. May 2018 Edition - Go to MDwise.org/Providers for latest version.

Transcription

1 Quick Contact Guide May 2018 Edition - Go to MDwise.org/Providers for latest version.

2 MDwise Product Information Hoosier Healthwise Packages A & C, PE Children under age of 19 and Pregnant Women % of the Federal Poverty Level (FPL) Hoosier Healthwise Helpline: Healthy Indiana Plan Packages: HIP Basic, HIP Plus, HIP State Plan (Basic/Plus) Adults ages Parents of CHIP children 0-138% Federal Poverty Level (FPL) HIP Helpline: GET-HIP-9 General Information Customer Service/Transportation Fax: or Prior Authorization Prior Authorization Quick Contact Guide Services: Medical Services ext Fax: (Please refer to the delivery systems contact info for more specific phone and fax numbers) MDwise.org/for-providers/forms/prior-authorization MDwise 1200 Madison Avenue, Suite 400 Indianapolis, IN Behavioral Health Contracting and Credentialing ext Right Choices Program or Fax: Claim Disputes & Appeals (By Delivery System) Excel Network, Indiana University Health, Total Health, Eskenazi Health Community Health Network (CHN) *Includes Behavioral Health and Family Planning MDwise St. Catherine (HHW Only) MDwise Behavioral Health Enrollment 1200 Madison Avenue, Suite 400 Indianapolis, IN Fraud & Abuse or MDwise, Inc. P.O. Box Indianapolis, IN ATTN: Claim Dispute Team MDwise St. Catherine P.O. Box

3 MDwise Select Health Network (HHW Only) MDwise Select Health Network P.O. Box (HHW Only) P.O. Box MDwise Delivery System Claims Contact Information MDwise Excel MDwise Indiana Health University MDwise Total Health MDwise Community Health Network (CHN) or Fax: ext or Fax: or or Fax: or Fax: Fax: Fax: or Fax: or

4 MDwise St. Catherine Behavioral Health or (Hospital Auths Only) (Toll Free Prior Auth) (All Other Auths) Fax: Fax: St. Mary Medical Center Providers Munster Community Hospital Providers St. Catherine Hospital Providers MDwise Select Health Network (SHN) Fax: MDwise Eskenazi Health or or Fax: or

5 MDwise Hoosier Healthwise Contact Information MDwise.org/providers MDwise Hoosier Healthwise Customer Service MDwise Hoosier Healthwise Customer Service P.O. Box Indianapolis, IN or MDwise Claims Submission Information MDwise Delivery System Claims Medical & Behavioral Health Claims for: MDwise Excel MDwise Community Health Network MDwise IU Health MDwise Eskenazi MDwise Total Health Family Planning Claims for: MDwise St. Catherine MDwise Select Health Network MDwise Hoosier Healthwise P.O. Box Eagan, MN **excludes those Delivery Systems who bill to CMCS** Change Health/Emdeon/WebMD Payer ID: Medical & Behavioral Health Claims P.O Box Relay Health Professional Payer ID: 2235 Relay Health Institutional Payer ID: 2911 Emdeon: St. Catherine Medical & Behavioral Health Claims MDwise St. Catherine P.O. Box Relay Health/McKesson Professional Payer ID: 2235 Relay Health/McKesson Institutional Payer ID: 2911 Emdeon

6 MDwise Select Health Network (SHN) Medical & Behavioral Health Claims MDwise Select Health Network P.O. Box Relay Health: 6139 MDwise Hoosier Healthwise Dental Claims (All Delivery Systems) Claims should be sent to: DentaQuest of IN-Claims PO Box 2906 Milwaukee, WI Pharmacy Help Desk Prior Authorization Pharmacy Appeals Hoosier Healthwise Pharmacy Information Preferred Drug List Electronic Claims should be sent to: Via Clearinghouse - Payer ID CX014 MDwise Hoosier Healthwise Pharmacy Claims (All Delivery Systems) Fax: Fax: RxBIN: PCN: ASPROD1 RxGRP: MDW MDwise.org/for-providers/pharmacy-resources/hoosier-healthwise 6

7 MDwise Healthy Indiana Plan (HIP) Contact Information MDwise.org/providers MDwise Healthy Indiana Plan Customer Service MDwise Healthy Indiana Plan P.O. Box Indianapolis, IN MDwise Enrollment Broker Maximus GET-HIP-9 or MDwise Claims Submission Information MDwise Delivery System Claims Medical & Behavioral Health Claims for: MDwise Excel MDwise Community Health Network MDwise IU Health MDwise Eskenazi MDwise Total Health MDwise St. Catherine MDwise Select Health MDwise HIP Claims P.O. Box Eagan, MN MDwise Healthy Indiana Plan Dental Claims (All Delivery Systems) General Provider and Authorization Line Change Health/Emdeon/WebMD Payer ID: WebMD/Emdeon Institutional Payer ID: 12K81 WebMD/Emdeon Professional Payer ID: SX172 McKesson/Relay Health Institutional Payer ID: 4976 McKesson/Relay Health Professional Payer ID: 4481 Dental Claims Address: DENTAQUEST of IN Claims P.O. Box 2906 Milwaukee, WI *Include address on electronic claims MDwise Pharmacy Claims (All Delivery Systems) Pharmacy Help Desk Prior Authorization Pharmacy Appeals Fax Healthy Indiana Plan Pharmacy Information Preferred Drug List Electronic Claims should be sent: Via Clearinghouse - Payer ID CX Fax: RxBIN: PCN: ASPROD1 RxGRP: MDW MDwise.org/for-providers/pharmacy-resources/healthyindiana-plan 7

8 HHW-HIPP0463 (5/16) (5/18) MDwise.org/Providers