Network Status Update and Prior Authorization Requirements for Non-Participating Providers
Managed Health Services (MHS) is implementing updates to its provider network and prior authorization (PA) requirements to enhance care coordination, promote use of in-network providers, and ensure responsible management of healthcare costs.
Effective November 1, 2025, prior authorization is required for all Medicaid services rendered by non-participating providers.
Current Network Status
MHS has received approval from the Indiana Office of Medicaid Policy and Planning (OMPP) to close select provider networks:
- Independent Laboratories: Closed statewide (effective July 14, 2025)
- Durable Medical Equipment (DME): Closed statewide (effective July 14, 2025)
- Behavioral Health (Types 110, 111, 114): Closed in Marion County (effective July 14, 2025)
- Chiropractic Services: Closed statewide (effective September 2, 2025) with the following exceptions: Newton, Jasper, Starke, Pulaski, Benton, Warren, Fulton, Marshall, Kosciusko, Dearborn, Ohio, Switzerland
- Applied Behavior Analysis (ABA): Closed statewide (effective March 26, 2026)
All other provider types will be assessed based on network needs.
Prior Authorization Requirements
Non-Participating Providers
Prior Authorization is required prior to rendering any services. Approval is granted only when services are medically necessary and no in-network provider is available.
PA is NOT required for:
- Emergency services
- Urgent care
- Family planning services
- Certain preventive services
Participating Providers
The rendering, ordering, or referring provider must submit the PA request at least two (2) days prior to service.
MHS will review requests to confirm medical necessity and determine if an in-network provider is available.
If an in-network provider is available, the request may be denied and the member redirected to a contracted provider.
Important Notes
Prior to this policy, non-participating providers were able to deliver services following network closures.
With implementation of the PA requirement, services will require approval and members will be directed to in-network providers whenever clinically appropriate.
📞 Contact: (877) 647-4848 | Monday–Friday, 8:00 a.m.–5:00 p.m. ET