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Pharmacy Prior Authorization and Billing Information for MHS Healthy Indiana Plan (HIP) and Hoosier Care Connect Members

Date: 06/27/16

Attention Providers:

Pharmacy Prior Authorization and Billing Information for MHS Healthy Indiana Plan (HIP) and Hoosier Care Connect Members

MHS provides pharmacy benefits for our HIP and Hoosier Care Connect Members. MHS utilizes a distinct Preferred Drug List (PDL) for our HIP and Hoosier Care Connect members that can be found on our website at mhsindiana.com/for-providers/provider-forms/provider-pharmacy-information. Coverage limits, PA requirements and other program exceptions are clearly noted on the PDL.

Most pharmaceuticals for HIP and Hoosier Care Connect members are processed through the outpatient pharmacy benefit using our Pharmacy Benefit Manager, US Script; however, some drugs are required to process through the MHS medical benefit.

Drugs Processed through the MHS Medical Benefit for HIP and Hoosier Care Connect Members

The following types of drugs are reviewed and processed through the MHS medical benefit:

  • Injectable drugs given at a provider location such as a physician’s office or outpatient clinic
  • Chemotherapy
  • Home Infusion Therapy including enteral and parenteral nutrition, injectable antibiotic therapy and chemotherapy.

Authorization for drugs processed through the MHS medical benefit should be sent using the IHCP Universal Prior Authorization request form and faxed to MHS at 1-866-912-4245. All requests must contain the drug’s HCPCS code, treatment dose and duration. For more information on prior authorizations, visit us at mhsindiana.com/for-providers or call MHS Provider Services at 1-877-647-4848.

Claims for medications through the medical benefit should be sent on a CMS 1500 claim form and submitted through the standard billing process. Billing information can be found at mhsindiana.com/for-providers/provider-guides.

Thank you for being our partner in care.

Sincerely,
MHS Pharmacy