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  • Eft Era Vendor Request Form - Mdwise - Mdwise

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EFT & ERA Vendor Request Form Date of Request: Please check the setup(s) being requested: EFT ERA Contact Requesting EFT/ERA Vendor SetUp: Name: Title: Phone: Fax: Special Instructions for EFT:.

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Our Medicaid Plans MDwise works with the State of Indiana and Centers for Medicare and Medicaid Services to bring you the Hoosier Healthwise and Healthy Indiana Plan health insurance programs.

* You can also call MDwise customer service at 800-356-1204.

You can check the status of your application online or by calling 1-800-403-0864. You will need to have your case number to check the status of your application.

Provider Enrollment Inquiries If you have questions about IHCP provider enrollment, enrollment status or provider profile updates, call Customer Assistance at 800-457-4584 and select option 2, and then option 1 to check provider enrollment status or option 3 to update provider enrollment information.

Agency Details Website: Centers for Medicare and Medicaid Services (CMS) Contact: Contact the Centers for Medicare and Medicaid Services (CMS) Local Offices: Contact State Medicaid Offices. Toll Free: 1-800-633-4227. ... TTY: 1-877-486-2048. Forms: Centers for Medicare and Medicaid Services Forms.

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

You can also call 1-800-403-0864 to make the change.

Who is eligible for Indiana Medicaid Program? Household Size*Maximum Income Level (Per Year)1$16,9712$22,9303$28,8884$34,8464 more rows

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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
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
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