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For Providers. For Staff. For Members of the Media. For Vendors. How it Works You may visit any authorized provider. PMPs can register to use our Member Health Profile tool and view services that their members have received over the past 12 months.
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This tool will allow you to see services including:. To register, please use the training guide. If you have any questions, please reach out to your MDwise delivery system provider relations representative. These changes will be effective on June 1, Information concerning the scheduled changes is as follows:. A prescription will be needed for these medications to enable claims processing through one of the contracted network pharmacies AllianceRx Walgreens Prime, IU Health Retail, or Eskenazi Retail Pharmacies.
Providers are encouraged to reach out to their assigned MDwise provider relations representative for any questions or concerns. Alternatively, you may contact MDwise customer service at or send an email inquiry to pharmacy mdwise. We thank you for partnering with MDwise to provide quality care for our members.
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Per the MDwise Provider Manual:. These changes will be effective on April 1, and June 1, Edgepark has been a trusted provider for many years, offering fast and easy ordering of medical supplies delivered to the home. Advantages of the Edgepark Program include:. Please review, sign, and return to Edgepark timely. MDwise will continue to operate under its current brand. McLaren has 26, employees and more than 52, network providers. They can be accessed below: MDwise Claims Forms.
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Become a MDwise Provider Learn more about becoming a provider. Welcome Providers Welcome to the MDwise network. As a part of that process, we perform routine pre and post payment audits. We realize it is important to remind our hospital partners of our criteria for these services. Readmissions that occur after 3 calendar days will be treated as separate stays for payment purposes but will be subject to medical review.
If it is determined that a discharge is premature, payment made as a result of the discharge or readmission may be subject to recoupment. Readmissions within 3 days deny without any review. Medical reviews will be completed for readmissions more than 3 days after discharge. Inpatient readmissions within three days following a previous hospital admission for any facility with the same or related diagnosis, should be billed on one claim see Inpatient Hospital Services. Inpatient readmissions within days following a previous hospital admission will deny for medical review. Collect the medical records for the inpatient readmission.
Submit the completed form and supporting medical records to MDwiseclaims mclaren. MDwise will send an acknowledgement letter within 10 calendar days of receipt and will send a decision letter to the informal dispute within 30 calendar days. If you have questions regarding the 1 st Level Readmission Dispute process, please contact MDwise at August 5, Effective September 1, , the Valence Claims Portal will be retired mdwportal. Please refer to your Clearinghouse, or paper copy.
The state reviewed these claims and determined that based on how the claim was billed, this payment was made in error. Please verify with the state that your billing information submitted on the claim is correct.
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