1. Claims Processing and Credentialing Coordination
MDwise Behavioral Health
Hi, My name is Nichole Young and I am the Behavioral Health Provider Relations representative for MDwise.
Here with us also today, we have (Introduce anyone in attendance from Mdwise).
Before we get started, I ask that you hold all questions until the end of the presentation.

2. Claims Processing Claim Submission
Contracted providers must submit claims to MDwise within 90 days of the date of rendering the service
When MDwise is secondary, claim must be submitted within 90 days of the date on the primary EOB
Claim Inquiry
One Form for all MDwise Programs
Claims Inquiry Forms
Customer Service:
Claim Disputes
Submit dispute within 60 days of the date on EOB
Claims timelines are one of the most important ways to avoid a claims denial.
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Continuing on timelines and claims disputes… (next slide)

3. Claims Disputes Claim Dispute Process
The MDwise Claim Dispute team utilizes an electronic dispute process:
Provider completes the Claims Dispute Form found at on the For Providers page, under Claim Forms
Completed form and supporting documents are sent via
One claim per form, one form per please.
Received is routed to a Claims Dispute work queue where a ticket number will be issued and an notification will be sent back immediately
The Claim Dispute team will review the submitted dispute and work the cases to resolution (uphold or overturn)
Once a resolution is reached, the claims payer will be notified of the need to reprocess the claim, if necessary
An notification will then be sent to the provider, referencing the dispute and ticket number, on the resolution determination
*review slide*
Ticket number mimics the same process our enrollment team is currently using to log and work enrollments from providers.
When submitting the Claims Dispute Form to the address, please make sure you include the Members name and date of service as the subject for the . This will ensure the ticket number matches that specific dispute, should you have more than one dispute for the member.
Please do not include any PHI such as their RID number in the subject line.
Please note only one dispute form per .
Now to move on to some BH changes…

4. - MDwise credentials Community Mental Health Centers as organizations.
Credentialing
Credentialing
- MDwise credentials Community Mental Health Centers as organizations.
- Participating providers need to be rostered, rosters are sent to the credentialing representative at each CMHC on a monthly basis.
- Roster updates and enrollments need to be ed to

5. MDwise Behavioral Health Contacts
Contact Information
Director, Stacy Tunon Watson, LCSW, LCAC
Manager, Holli Mahoney, LMHC
Provider Representative, Nichole Young, RN
Coordinator, Debra Pickett
Behavioral Health dedicated
If you have any questions on any of the information we have reviewed or if you want to discuss something you did not see in this presentation, please contact me, Nichole Young.
Also if you have any BH questions, please feel free to utilize our BH dedicated address,
Please send all contracts, enrollments, and new provider inquiries to