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To request access: Email us, call 317-621-7580 or fax request form to 317-355-6084.
Contact provider relations
Provider forms and information
Print and fill out the following forms and submit them to our office:
Providers not listed in the above directories are Tier 3.
MDWise and Hoosier Healthy Indiana Plans
Fee schedule information
Jan | Feb | March | April | May | June
Please note: Not all ProHealth providers participate in all plans.
To become a participating provider with Indiana ProHealth Network you must have a completed and up-to-date CAQH application. If you would like ProHealth to obtain this application for you, please complete the CAQH Provider Data Sheet. Otherwise, please see the CAQH website for additional information at www.caqh.org.
Credentialing requirements checklist:
Electronic COB information acceptance
ProHealth is accepting Other Payer Primary COB information within your electronic claims. Please submit Primary Other Payer processing information using HIPAA-standard codes and amounts at the line-item detail level within your electronic claim files. Electronically submitted Primary COB information is processed at initial adjudication, and eliminates secondary paper claim and paper primary EOB submission requirements when ProHealth is the secondary payer.
ProHealth is accepting EFT/835 enrollment. Please submit the completed 835/EFT enrollment form to Michele Dowd at 317-355-6084 (fax) or email@example.com.
Download: EFT/835 Enrollment form