Provider Notice: Implementation of Prior Authorization Requirement for Non-Participating Providers Effective November 1, 2025

Date: 09/19/25

Managed Health Services (MHS) provides health coverage for members enrolled in Hoosier Healthwise (HHW), the Healthy Indiana Plan (HIP), and Hoosier Care Connect (HCC). We have an important update for all non-participating providers. MHS is implementing a new policy that will require Prior Authorization (PA) for all Medicaid services rendered by non-participating providers. This change is set to take effect on November 1, 2025.

The primary goal of this policy is to enhance care coordination, encourage the use of contracted network providers, and manage healthcare costs responsibly. By requiring PA, MHS can evaluate the appropriateness of care and ensure that members are directed to in-network providers whenever it is clinically appropriate.

Non-Participating Providers

Non-participating providers must obtain PA from MHS before delivering any services to our members. MHS will approve out-of-network only if medically necessary and no in-network provider can provide the service. PA is not required for emergency services, urgent care, family planning, some preventive care services, and select self-referral services. 

Participating Providers

The rendering, ordering, or referring provider must request prior authorization for services from a non-contracted provider at least two days before care is delivered. MHS will review the request to confirm medical necessity and ensure no in-network provider can provide the service. If an in-network provider is available, the request may be denied and the member redirected to a contracted provider.

We appreciate your cooperation and understanding as we implement this change. If you have any questions or need further clarification, please contact MHS at 1-877-647-4848.

Thank you for being our partner in care.