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  • Informal Claim Dispute / Objection Form - Mhs Indiana

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6204 1-877-647-4848 mhsindiana.com Members with speech or hearing disabilities call 1-800-743-3333 for TTY/TDD. MHS is a health insurance provider that has been proudly serving Indiana residents for two decades through Hoosier Healthwise, the Healthy Indiana Plan and Hoosier Care Connect. MHS also offers a qualified health plan through the Health Insurance Marketplace called Ambetter from MHS. MHS is your choice for affordable health insurance. Learn more at mhsindiana.com.

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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.

submitted within 180 calendar days of the date of service or discharge.

Appeals need to be filed within 60 calendar days from the date on the letter telling you about the decision. A member or the member's representative may write, phone, fax, or email the appeal request and consent to: Written: MHS Appeals, P.O. Box 441567, Indianapolis, IN 46244.

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.

Physicians must file Medicaid fee-for-service claims within 180 calendar days of the date of service. The current timely filing limit is 365 calendar days. For inpatient claims, the 180-day limit will be based on the IHCP member's date of discharge.

Claims must be filed within 180 days of the Date of Service (DOS) for non-contracted providers and within 90 days of DOS for contracted providers. Claims should be submitted to MHS via a CMS-1500 professional claim form. Claims may be submitted via EDI (preferred), MHS web portal or paper.

Complaint/Grievance Ambetter logs and tracks all complaints/grievances whether received verbally or in writing. A provider has thirty (30) calendar days from the date of the incident, such as the original Explanation of Payment date, to file a complaint/grievance.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
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