MDwise Product Comparison

Transcription

1 Quick Contact Guide

2 MDwise Product Comparison Basic Information Members Served Customer Service Hoosier Healthwise Healthy Indiana Plan Hoosier Care Connect Operations began Jan Statewide operations MDwise.org/providers 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) Operations began Jan Statewide operations MDwise.org/providers Adults ages Parents of CHIP children Up to 138% FPL HIP Basic HIP Plus HIP State Plan Basic HIP State Plan Plus Operations began April 2015 Statewide operations MDwise.org/providers Aged, blind and disabled Children receiving adoptive services Call 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 Managed by MDwise corporate only Not a delivery system model Claims/ 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 Adjudicated by MDwise Checks issued by MDwise Claim filing limit: 90 days Remittance from MDwise 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 Submit prior authorization requests to MDwise. Other Program Responsibilities State Website Information 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 Credentialing, quality improvement program, provider relations, hearings/appeals, utilization management, Right Choices program administration, behavioral health integration, disease management indianamedicaid.com HIP.in.gov Pharmacy Indiana Medicaid formulary Catamaran prior authorization/drug rebate HP processes claims Formulary indianamedicaid.com, click Providers, then Pharmacy Services MDwise HIP formulary MedImpact prior authorization/drug rebate Formulary MDwise.org/providers/hip/pharmacy select HIP Basic, HIP State or HIP Plus MDwise formulary MedImpact prior authorization/drug rebate MDwise processes claims Formulary: MDwise.org/providers/hcc/pharmacy Other Stakeholders Hoosier Healthwise Helpline: Anthem (MCE): MHS (MCE): Anthem HIP Plan: MHS HIP Plan: Enhanced Service Plan ESP : HIP Helpline:1-877-GET-HIP-9 Hoosier Care Connect Helpline: MedImpact (Hoosier Care Connect pharmacy):

3 MDwise Hoosier Healthwise Contact Information MDwise.org/providers General Information Customer Service/Transportation Fax: or Provider Services: Medical Services Fax: MDwise Hoosier Healthwise Customer Service P.O. Box Indianapolis, IN 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 indianamedicaid.com (Choose Providers, then Pharmacy Services)/ Fraud & Abuse or Claims Disputes, Grievances & Appeals Behavioral Health ONLY Medical ONLY (contracted providers) Medical ONLY (non-contracted providers) MDwise P.O. Box Indianapolis, IN Attention: Grievances & Appeals 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 Claims Inquiries Fax: Provider Representative Family Planning Claims MDwise St. Vincent MDwise Excel Network P.O. Box 7303 London, KY EDI Payer ID: mental/behavioral health eff MDwise Family Planning Claims McKesson/Relay Health Institutional Payer ID: 4976 Emdeon/WebMD Institutional Payer ID: 12K81 Claims Inquiries / / Fax: / Provider Representative Fax: Family Planning Claims MDwise St. Vincent P.O. Box Indianapolis, IN EDI Payer ID Relay Health: 2235 Emdeon: MDwise Family Planning Claims McKesson/Relay Health Institutional Payer ID: 4976 MDwise St. Catherine Claims Inquiries / (Hospital Auths Only) (Toll Free Prior Auth) (All Other Auths) Fax: Behavioral Health Fax: Provider Representative St. Mary Medical Center Providers Munster Community Hospital Providers (includes behavioral claims) Family Planning Claims St. Catherine Hospital Providers MDwise St. Catherine P.O. Box Indianapolis, IN Payer ID Emdeon Relay Health/McKesson 2235 mental/behavioral health eff MDwise Family Planning Claims McKesson/Relay Health Institutional Payer ID: 4976 Emdeon/WebMD Institutional Payer ID: 12K81 MDwise Eskenazi Health (formerly MDwise Wishard) Claims Inquiries Provider Representative / Fax: / MDwise Eskenazi Health All Medical Claims: Emdeon/WebMD Institutional Payer ID: 12K81 McKesson/Relay Health Institutional Payer ID:

5 MDwise SHN Claims Inquiries MDwise Total Health Claims Inquiries Phone and Fax: / Provider Representative Fax: Fax: Provider Representative Family Planning Claims MDwise Select Health Network P.O. Box Indianapolis, IN EDI Payer ID Relay Health: 6139 MDwise Family Planning Claims McKesson/Relay Health Institutional Payer ID: 4976 Emdeon/WebMD Institutional Payer ID: 12K81 MDwise Total Health All Medical Claims: Emdeon/WebMD Institutional Payer ID: 12K81 McKesson/Relay Health Institutional Payer ID: 4976 MDwise St. Margaret Claims Inquiries / Fax: Provider Representative (includes behavioral claims) Family Planning Claims MDwise St. Margaret P.O. Box Indianapolis, IN Payer ID Emdeon Relay Health/McKesson 2235 MDwise St. Anthony P.O. Box Indianapolis, IN MDwise Indiana University Health (formerly MDwise Methodist) MDwise Family Planning Claims McKesson/Relay Health Institutional Payer ID: 4976 Emdeon/WebMD Institutional Payer ID: 12K81 Professional Claims: SX172 Claims Inquiries Fax: Provider Representative MDwise IU Health Claim Disputes Address P.O. Box Indianapolis, IN Emdeon/WebMD Institutional Payer ID: 12K81 McKesson/Relay Health Institutional Payer ID:

6 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: Claims address: DENTAQUEST of IN-Claims N. Corporate Parkway Mequon, WI Electronic Claims 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 Claims Effective all HIP claims regardless of date of service should be mailed to: MDwise HIP Claims WebMD/Emdeon McKesson/Relay Health Institutional Payer ID: 12K81 Institutional Payer ID: 4976 Professional Payer ID: SX172 Professional Payer ID: 4481 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) 6

7 MDwise Healthy Indiana Plan Delivery Systems MDwise Eskenazi Health (formerly MDwise Wishard) Provider Representative MDwise Indiana University Health (formerly MDwise Methodist) Provider Representative / Fax: / / Fax: MDwise Excel Network Provider Representative MDwise St. Margaret Fax: Provider Representative MDwise Total Health (Inpatient/Observation) (All Other Auths) Phone and Fax: / MDwise St. Catherine (Hospital Auths Only) (Toll Free Prior Auth) (All Other Auths) Fax: Behavioral Health Fax: Provider Representative Fax: MDwise SHN Fax: Provider Representative Provider Representative St. Mary Medical Center Providers Munster Community Hospital Providers St. Catherine Hospital Providers MDwise St. Vincent / Fax: / Provider Representative Fax: Note: Medical Management and prior authorization for behavioral health Contact HIP member s delivery system 7

8 General Information Customer Service Members and providers may call customer service for all Hoosier Care Connect related questions Fax: or NURSEon-call:, Option #4 Indiana Relay services: Provider Services Fax: Fax: and Care Management Fax: or Right Choices Program Disease Management Fax: or Hoosier Care Connect Claims (UB04, CMS-1500, Pharmacy) (HP), formerly EDS Fax: Hoosier Care Connect Payor ID info: WebMD/Emdeon Institutional Payer ID: 12k81 Professional Payer ID: sx172 MDwise Hoosier Care Connect Contact Information MDwise.org/providers MDwise Hoosier Care Connect Customer Service Indianapolis, Indiana MDwise Hoosier Care Connect Provider Services Indianapolis, Indiana MDwise Hoosier Care Connect Indianapolis, Indiana MDwise Hoosier Care Connect Care Management Indianapolis, Indiana Fraud & Abuse Fax: or MDwise Hoosier Care Connect Disease Management Indianapolis, Indiana MDwise Hoosier Care Connect Claims Birmingham, Alabama McKesson/Relay Health Institutional Payer ID: 4976 Professional Payer ID: 4481 Hoosier Care Connect Dental Claims Claims should be sent to: DentaQuest of IN-Claims N. Corporate Parkway Mequon, Wisconsin Electronic Claims should be sent to: or Via Clearinghouse - Payer ID CX014 DentaQuest, LLC N. Corporate Parkway Mequon, Wisconsin

9 Hoosier Care Connect Contact Information (cont.) Hoosier Care Connect Pharmacy and Pro-Dur Preferred Drug List Processed by MedImpact Fax: Pharmacy Pharmacy Help Desk: : Fax: Pharmacy Appeals Fax: MDwise Hoosier Care Connect Indianapolis, Indiana RxBIN: PCN: ASPROD1 RxGRP: MDW Services Requiring Please refer to the Hoosier Care Connect List on our website at MDwise.org. 9

10 MDwise.org Last updated October 2015 APP0117 (10/12) HCCP0031 (3/15)