1. MDwise Provider Portal
2018 IHCP Annual Workshop
Good Afternoon, my name is David hoover. I am the provider representative for Region 5, which includes Kokomo, Logansport, Muncie, Decatur and Portland, Indiana. Today we will briefly go over MDwise as a whole and I will give some updates on things happening in the new year.
MDwise Provider Portal
HHW-HIPP0583 (9/18)

2. Agenda
MDwise History
Updates
Provider Page
Accessing the Portal
Eligibility
Claim Status
Member Health Profile
Quality Reports
Portal Registration
Helpful Hints
Resources
Questions

3. 2007: MDwise selected to provide care through the Healthy Indiana Plan
MDwise History
1994: MDwise founded as Indiana-based nonprofit health care company Central Indiana Managed Care Organization, Inc. (CIMCO), utilizing a delivery system model
2001: CIMCO teamed up with IU Health Plan and formed into MDwise, Inc., serving more than 55,000 Hoosier Healthwise members.
2007: MDwise begins service Care Select (now Hoosier Care Connect) members
2007: MDwise selected to provide care through the Healthy Indiana Plan
2018: MDwise acquired by Michigan-based McLaren Health Care; one of Michigan’s largest integrated health systems
MDwise’s history began back in 1994 when we were founded as CIMCO. From 2001 to 2014, MDwise offered medical coverage to Indiana residents through the Hoosier Healthwise, Hoosier Care Connect, formerly Care Select, HIP and Marketplace programs. Our focus shifted over the last couple of years from all 4 medical programs to just Hoosier Healthwise and HIP. And in 2017, MDwise was purchased by McLaren Health Care, a Michigan-based health system with a significant health plan operation across the state of Michigan.

4. Who Is McLaren Health Care?
Is one of the largest integrated health care systems in Michigan
Owns 15 hospitals, including Barbara Ann Karmanos, nationally renowned for their cancer care and outcomes
Employs over 500 physicians
Trains over 550 residents annually
Has a workforce of over 20,000
Owns McLaren Health Plan, who covers over 265,000 members in Medicaid, commercial, and Medicare Supplemental markets.

5. MDwise – McLaren Synergies
Sharing Best Practices between MDwise and McLaren Health Plan, such as:
Care Management
Opioid Crisis Management
Effectively managing inappropriate ER utilization
Streamlining Prior Authorizations
Pay for Value Physician Incentive programs
Claims adjudication
Results are Demonstrating:
Improvement in health care outcomes for our members
Enhanced access for members
Greater administrative efficiencies, which allow more health care dollars to be spent on the actual delivery of medical care

6. Updates
Effective 1/1/19:
MDwise is restructuring it’s Delivery System model to:
Improve claim payment timeliness and accuracy
Streamline and reduce administrative redundancy for providers
Provide greater access for our members
One standard authorization list
One point of contact for all authorization requests
One claim submission address
Non-Excel Delivery System contracts
Providers not contracted with MDwise Excel must contract to stay in network.
Effective January 1, 2019, MDwise will begin operating as a single network, MDwise Excel. This will show when checking eligibility in the MDwise Portal as well as the state systems. Along with this change, MDwise delivery system contracts will expire December 31, If you are not currently contracted as a MDwise Excel provider and want to be able to see MDwise members, you will need to contract as a MDwise excel provider. Please reach out to your dedicate provider representative to begin this process. Also changing will be out claims processing, our prior authorization process and requirements, and our MDwise portal access. All of these items are covered in this presentation, so lets get started!

7. Effective 1/1/19: Eligibility: Updates
When determining eligibility, verify:
Is the member eligible for services today?
Which Indiana Health Coverage Program plan are they enrolled?
If the member is in Hoosier Healthwise or Healthy Indiana Plan, are they assigned to MDwise?
Who is the member’s Primary Medical Provider (PMP)?
Beginning in January, you will be able to utilize the state website for the members Program and MCE. The assigned network or delivery system will always be MDwise Excel. To verify a PMP, you will use the MDwise provider portal, as you do now.
Provider Healthcare Portal
MDwise Provider Portal
IHCP Program
Delivery System: MDwise Excel
MCE
Assigned PMP History
Assigned PMP

8. Effective 1/1/19 Prior Authorization One standard authorization list
One point of contact for all authorization requests
Submission timelines and process will not change
Go to MDwise.org for most up-to-date version of PA lists
MDwise.org
For Providers
Forms
Prior Authorization
Effective January 1st, our PA guides will update. There will be one PA list per program. The PA lists will still be housed on the Prior Authorization page. The current 2017 and prior PA lists will remain on this page to allow for review after the new year. Be sure you are reviewing the correct PA guides in the new year.

9. Provider Page

10. Provider Page

11. Provider Page Features:
Provider Manuals
Department Forms
Pharmacy Resources
Quality Education Materials
Contact Guides
New and Announcements
Provider Portal Access
ProviderLink Newsletter
How to Become a MDwise Provider
Prior Authorization Lists
Continuing Education Materials

12. Why use the Provider Page?
Updated versions of forms
Updated contact guides
Access to archived materials
Learn how to earn incentives through Quality
Print resources for your office to educate members on:
Smoking Cessation
Behavioral Health
Diabetes
Pregnancy

13. How to access the Provider Portal
Accessing the Portal
How to access the Provider Portal

14. Accessing the Portal

15. Accessing the Portal Access your Portal Profile Request an Account
View Sign-up Guide for Questions

16. Features of the MDwise Portal
Accessing the Portal
Features of the MDwise Portal
Claim Status
Claim Payment Information
Member Eligibility
Quality Reports
PMP Member Rosters
Member Health Profile
Care Management/Disease Management (CM/DM) Request Form
Secure Messages for Provider Relations

17. Accessing the Portal

18. Eligibility
Verifying Eligibility
Search by member RID or SSN
Original effective date
Eligibility Status
PMP History
Claim history for last 150 days

19. Claim Status
Tip: Search claims by member RID and date of service to see status on all claims submitted for this date (paid, denied, duplicate, pended)

20. MDwise Provider Portal
Claim Status
MDwise Provider Portal

21. The information is displayed in one interface and can be printed.
Member Health Profile
The Member Health Profile (MHP) is an online tool to help registered in-network PMP’s and specific Behavioral Health providers with coordination of care.
Allows the primary medical provider (PMP) and behavioral health (BH) provider to view their members medical and pharmacy claims for all of doctors that see the member.
The information is displayed in one interface and can be printed.
PMP’s can use this information to identify the gaps in care and better manage the members overall care plan.

22. How to Request Access to Member Health Profile:
Complete our online request form
Only PMP NPI’s should be used, Specialists/non-PMP’s will not be able to lookup users in the Member Health Profile.
Allow 5-7 business days for processing
If providers have technical issues getting registered or accessing the profile, please send an to
Please note:
This is not for claims questions.
Do not send any PHI

23. Member Health Profile

24. Member Health Profile

25. Member Health Profile

26. Quality Online Reports Quality Reports Members in need of services
PMP Panels

27. Missed Opportunities Report
Quality
Comparison Report
Compares individual provider office performance to all of MDwise.
Missed Opportunities Report
Shows opportunities at member appointments that were missed.
Example: An acute visit that can also count toward a well visit.
Year to Date Report
Shows where your office is compared to the previous year.
The comparison report shows where your office is compared to the rest of the MDwise providers

28. Quality Request Access Complete required fields and submit
Access granted within 2-3 business days

29. Resources 1 2 5 3 4 9
If you have questions on these forms or on the contracting process for MDwise Excel, be sure to contact your dedicated Provider Relations representative for your region, as shown here. 6 8 7

30. Resources Representative Territory Phone Email Paulette Means Region 1
Garrett Walker
Region 2
Michelle Phillips
Region 3, Hospice, Home Health
Jamaal Wade
Region 4
David Hoover
Region 5
Tonya Trout
Region 6
Rebecca Church
Region 7
Sean O’Brien
Region 8
Whitney Burnes
Region 9
Nichole Young
Behavioral Health
(CMHC, OTP, IMD or Residential)
Michelle Phillips, our dedicate Home Health and Hospice rep is now covering region 3 as well. If you are a DME provider, please reach out to the Representative in you respective region. Also, territory reps are now covering ABA providers as well. For behavioral health, Nichole young covers CMHC’s, OTP’s, IMD’s and residential providers. All other BH providers should contact their territory reps.

31. MDwise Customer Service
Resources
MDwise Customer Service
MDwise Provider Relations
ext. 5800
Enrollment submissions & updates go to
Provider Relations Territory Map
MDwise Website

32. Questions