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  • Provider Claim Adjustment Request Form - Mhs Indiana

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Est adjustment of claim payment received that does not correspond with payment expected. Adjustment Requests must be submitted within 67 calendar days of the original determination of the claim (the date of your Explanation of Payment or EOP). All fields in the box immediately below are required information Provider name: Provider Tax ID Number: Control Number: Date(s) of Service: Member Name: Member (RID) Number: Reason for Adjustment Request (please check): Claim was denied for no author.

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For further assistance, you can call Provider Services at 1-877-647-4848 or see our Account Registration Guide (PDF).

Contracted or In-Network providers: 90 calendar days from the date of service or discharge date. within 365 days from the date of service. Claim must be filed with the newborn's Medicaid Identification number.

Managed Health Services (MHS) is a health insurance provider that has been proudly serving Indiana residents for 25 years through Hoosier Healthwise, the Healthy Indiana Plan (HIP) and Hoosier Care Connect.

CLAIMS REFUNDS: You can find out more about the information in this Guide in the MHS Provider Manual, online at mhsindiana.com/provider-guides, or by contacting MHS at 1-877-647-4848.

Call us at 1-877-822-7196 or in the Indianapolis area 317-822-7196. There are representatives that can help you.

MHS covers prescription medications and certain over-the-counter (OTC) medications when ordered by an Indiana Medicaid enrolled MHS practitioner. Generic Specialty Drugs The pharmacy benefit has a Preferred Drug List (PDL).

The Healthy Indiana Plan is a health-insurance program for qualified adults. The plan is offered by the State of Indiana. It pays for medical costs for members and could even provide vision and dental coverage. It also rewards members for taking better care of their health.

Managed Health Services (MHS) is a managed care entity that has been serving the state of Indiana for more than 25 years through the Hoosier Healthwise and Hoosier Care Connect Medicaid programs and the Healthy Indiana Plan (HIP) Medicaid alternative program.

The Healthy Indiana Plan provides coverage for qualified low-income Hoosiers ages 19 to 64, who are interested in participating in a low-cost, consumer-driven health care program.

The Healthy Indiana Plan covers Indiana residents between the ages of 19 and 64 whose family incomes are less than approximately 138 percent of the federal poverty level and who aren't eligible for Medicare or another Medicaid category.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232