|Jenny||Provider relations manager||E-mail Jenny|
|Lori W.||Medicare program manager||E-mail Lori W.|
|Salena||Medicaid program manager||E-mail Salena|
|Amanda||Provider relations coordinator||E-mail Amanda|
|Carol||Provider relations coordinator||E-mail Carol|
|Dawn||Provider relations coordinator||E-mail Dawn|
|Hollie||Business information coordinator||E-mail Hollie|
|Jenna||Credentialing and enrollment supervisor||E-mail Jenna|
|Adrianne||Credentialing coordinator||E-mail Adrianne|
|April||Credentialing coordinator||E-mail April|
|Aletha||Credentialing coordinator||E-mail Aletha|
|Julia||Credentialing coordinator||E-mail Julia|
|Julie||Credentialing coordinator||E-mail Julie|
|Kim||Credentialing coordinator||E-mail Kim|
|Amy||Provider enrollment coordinator||E-mail Amy|
|Denise||Provider enrollment coordinator||E-mail Denise|
|Dianne||Provider enrollment coordinator||E-mail Dianne|
|Lori J.||Provider enrollment coordinator||E-mail Lori J.|
|Melissa||Provider enrollment coordinator||E-mail Melissa|
|Sharon||Provider enrollment coordinator||E-mail Sharon|
Provider forms and information
- Change of Information form
- Termination of Care form
- Anthem Member Deletion form
- Anthem Outreach form
- W-9 revised
Gold and Silver Plans
- Tier 1 Provider and Facility Directory (highest level of reimbursement)
- Tier 1 Chiropractic Directory (chiropractic providers with highest level of reimbursement)
- Tier 2 Directory (second level of reimbursement)
Providers not listed in the above directories are Tier 3.
MDWise and Hoosier Healthy Indiana Plans
- MDwise Prior Authorization Contact Guide
- MDwise Panel Add Hold Request
- Hoosier Healthwise Healthy Indiana Plan Claims Inquiry Form
Fee schedule information
Please note: Not all ProHealth providers participate in all plans.
To become a participating provider with Indiana ProHealth Network you must have a completed and up-to-date CAQH application. If you would like ProHealth to obtain this application for you, please complete the CAQH Provider Data Sheet. Otherwise, please see the CAQH website for additional information at www.caqh.org.
To inquire about being in ProHealth, please e-mail Jenna.
Credentialing requirements checklist:
Electronic COB information acceptance
ProHealth is accepting Other Payer Primary COB information within your electronic claims. Please submit Primary Other Payer processing information using HIPAA-standard codes and amounts at the line-item detail level within your electronic claim files. Electronically submitted Primary COB information is processed at initial adjudication, and eliminates secondary paper claim and paper primary EOB submission requirements when ProHealth is the secondary payer.
ProHealth is accepting EFT/835 enrollment. Please submit the completed 835/EFT enrollment forms to Michele Dowd at 317-355-6084 (fax) or email@example.com.