Quick Contact Guide. October 2017 Edition - Go to MDwise.org/Providers for latest version.

Transcription

1 Quick Contact Guide October 2017 Edition - Go to MDwise.org/Providers for latest version.

2 MDwise Product Comparison Hoosier Healthwise Healthy Indiana Plan Basic Information Operations began Jan Statewide operations MDwise.org/providers Operations began Jan Statewide operations MDwise.org/providers Members Served Packages A, C, & P Children under the age of 19 living in a low-income household Less than 150% FPL (Package A) Between % FPL (Package C) Adults ages Parents of CHIP children Up to 138% FPL HIP Basic HIP Plus HIP State Plan Basic HIP State Plan Plus Customer Service Call Call Business Structure Administered by MDwise and its delivery systems throughout the state of Indiana Administered by MDwise and its delivery systems throughout the state of Indiana / Reimbursement Adjudicated by the delivery systems Checks issued by the delivery systems Claim filing limit: 90 days Remittance from delivery systems Checks issued by HIP delivery systems POWER Account managed by MDwise Claim filing limit: 90 days Remittance from HIP delivery system Authorization Required MDwise delivery systems closed network model Prior authorization required for services mandated by State and the delivery system MDwise delivery systems Prior authorization required for services mandated by State and the delivery system Other Program Responsibilities Credentialing, quality improvement program, provider relations, hearings/appeals, utilization management, claims adjudication, Right Choices program administration, behavioral health integration Credentialing, quality improvement program, provider relations, hearings/appeals, utilization management, claims adjudication, Right Choices program administration, behavioral health integration State Website Information indianamedicaid.com HIP.in.gov Pharmacy MDwise HHW Preferred Drug List (PDL) MedImpact prior authorization MedImpact processes claims Preferred Drug List (PDL) MDwise.org/hhw-find-a-drug MDwise HIP Preferred Drug List (PDL) (Basic, State or Plus) MedImpact prior authorization MedImpact processes claims Preferred Drug List (PDL) MDwise.org/providers/hip/pharmacy select HIP Basic, HIP State or HIP Plus Other Stakeholders Hoosier Healthwise Helpline: Anthem (MCE): MHS (MCE): CareSource (MCE): Anthem HIP Plan (MCE): MHS HIP Plan (MCE): CareSource (MCE): Enhanced Service Plan ESP : HIP Helpline:1-877-GET-HIP-9 2

3 MDwise Hoosier Healthwise Contact Information MDwise.org/providers General Information Customer Service/Transportation Fax: or MDwise Hoosier Healthwise Customer Service P.O. Box Indianapolis, IN Provider Relations Services: Medical Services Fax: (Please refer to the delivery systems contact info for more specific phone and fax numbers) MDwise Hoosier Healthwise Provider Services 1200 Madison Avenue, Suite 400 Indianapolis, IN Provider Services: Behavioral Health Contracting and Credentialing or ext MDwise Behavioral Health Contracting and Credentialing 1200 Madison Avenue, Suite 400 Indianapolis, IN Right Choices Program Fax: Preferred Drug List MDwise.org/providers/hhw/pharmacy Fraud & Abuse or Disputes, Grievances & Appeals Behavioral Health ONLY MDwise P.O. Box Indianapolis, IN Attention: Grievances & Appeals Medical ONLY (contracted providers) Medical ONLY (non-contracted providers) Submit to member s delivery system, except MDwise Eskenazi Health, IU Health and Total Health delivery systems submit to: MDwise P.O. Box Indianapolis, IN Attention: Grievance Coordinator MDwise P.O. Box Indianapolis, IN Attention: Grievance Coordinator 3

4 MDwise Hoosier Healthwise and HIP Maternity Delivery Systems MDwise Excel Network Inquiries MDwise St. Vincent Inquiries / Fax: / Fax: / Provider Representative Family Planning MDwise HHW Excel Network Change Health/Emdeon/WebMD Payer ID: For claims with dates of service MDwise Excel Network / Change Health/Emdeon/ WebMD Payer ID: For claims with dates of service / Provider Representative Fax: Family Planning MDwise St. Vincent P.O. Box Indianapolis, IN EDI Payer ID Relay Health: Professional Payer ID: 2235 Institutional Payer ID: 2911 Emdeon: MDwise Family Planning Change Health/Emdeon/WebMD Payer ID:

5 MDwise Hoosier Healthwise and HIP Maternity Delivery Systems MDwise St. Catherine Inquiries / MDwise SHN Inquiries (Hospital Auths Only) (Toll Free Prior Auth) (All Other Auths) Fax: Fax: Provider Representative Behavioral Health Fax: Provider Representative Family Planning St. Mary Medical Center Providers Munster Community Hospital Providers St. Catherine Hospital Providers MDwise St. Catherine P.O. Box Indianapolis, IN Payer ID Emdeon Relay Health/McKesson: Professional Payer ID: 2235 Institutional Payer ID: 2911 MDwise Family Planning Change Health/Emdeon/WebMD Payer ID: Family Planning MDwise Select Health Network P.O. Box Indianapolis, IN EDI Payer ID Relay Health: 6139 MDwise Family Planning Change Health/Emdeon/WebMD Payer ID:

6 MDwise Hoosier Healthwise and HIP Maternity Delivery Systems MDwise Total Health Inquiries / Phone and Fax: / Provider Representative Fax: MDwise Community Health Network Inquiries Provider Representative / Fax: / MDwise HHW Total Health MDwise Total health HIP Maternity MDwise Community Health Network Change Health/Emdeon/ WebMD Payer ID: All Medical Change Health/Emdeon/WebMD Payer ID: All Medical : Emdeon/WebMD Institutional Payer ID: 12K81 Professional : SX172 McKesson/Relay Health Institutional Payer ID: 4976 Professional Payer ID: 4481 Family Planning MDwise Community Health Network Change Health/Emdeon/ WebMD Payer ID: MDwise Family Planning / McKesson/Relay Health Professional Payer ID: 4481 Emdeon/WebMD Institutional Payer ID: 12K81 Professional : SX172 6

7 MDwise Hoosier Healthwise and HIP Maternity Delivery Systems MDwise Indiana University Health Inquiries / Fax: Provider Representative MDwise IU Health For with dates of service MDwise HHW IU Health Claim Disputes Address P.O. Box Indianapolis, IN All Medical Change Health/Emdeon/ WebMD Payer ID: For claims with dates of service All Medical : Emdeon/WebMD Institutional Payer ID: 12K81 Professional : SX172 McKesson/Relay Health Professional Payer ID: 4481 MDwise Eskenazi Health Inquiries / / Fax: / Provider Representative All Medical MDwise HHW Eskenazi Health For with dates of service MDwise Eskenazi health / Change Health/Emdeon/ WebMD Payer ID: For claims with dates of service All Medical : Emdeon/WebMD Institutional Payer ID: 12K81 Professional : SX172 McKesson/Relay Health Professional Payer ID: 4481 Hoosier Healthwise Dental should be sent to: DentaQuest of IN N. Corporate Parkway Mequon, Wisconsin Electronic should be sent to: or Via Clearinghouse - Payer ID CX014 DentaQuest, LLC N. Corporate Parkway Mequon, Wisconsin Hoosier Healthwise Pharmacy Pharmacy Help Desk: : Fax: Pharmacy Appeals Fax: RxBIN: PCN: ASPROD1 RxGRP: MDW 7

8 MDwise Healthy Indiana Plan (HIP) Contact Information MDwise.org/providers General Information Enrollment Broker Maximus GET-HIP-9 or Customer/Provider Service Fax: or MDwise Healthy Indiana Plan P.O. Box Indianapolis, IN Dental General Provider and Authorization line: address: DENTAQUEST of IN N. Corporate Parkway Mequon, WI Electronic should be sent: Direct entry on the web: dentaquest.com Or, Via Clearinghouse: Payer ID CX014 Include address on electronic claims: DentalQuest, LLC N Corporate Parkway Mequon, WI Right Choices Program Fax: Fraud & Abuse or Medical & Behavioral Health MDwise HIP P.O. Box Corpus Christi, TX Change Health/Emdeon/WebMD Payer ID: For with dates of service MDwise HIP McKesson/Relay Health Institutional Payer ID: 12K81 Pharmacy Pharmacy Help Desk: : Fax: Pharmacy Appeals Fax: RxBIN: PCN: ASPROD1 RxGRP: MDW Preferred Drug List MDwise.org/providers/hip/pharmacy (select HIP Basic, HIP State or HIP Plus) 8

9 Healthy Indiana Plan Delivery Systems MDwise Eskenazi Health Provider Representative / Fax: / MDwise Excel Network Provider Representative (Inpatient/Observation) (All Other Auths) MDwise Indiana University Health Provider Representative / Fax: MDwise St. Margaret (Inpatient/Observation) (All Other Auths) MDwise St. Catherine (Hospital Auths Only) (Toll Free Prior Auth) (All Other Auths) Fax: Provider Representative ext MDwise SHN Fax: Provider Representative Behavioral Health Fax: MDwise St. Vincent Provider Representative St. Mary Medical Center Providers Munster Community Hospital Providers St. Catherine Hospital Providers / Fax: / Provider Representative Fax: MDwise Community Health Network / Fax: / Provider Representative Note: Medical Management and prior authorization for behavioral health Contact HIP member s delivery system 9

10 HHW-HIPP0463 (5/16) HCCP0031 (3/15) MDwise.org/Providers