For Select Health Network Providers:

Indiana and Michigan Health Care Providers Provider Downloads (password required)
  • Alphabetical Provider List
  • Ancillary Providers
  • Specialty List
  • Pre Certification List
  • Biotech Injectable List
  • Prior Authorization Form
  • Provider Change Notification
  • Provider LOA Notification
  • Provider Newsletter
  • Provider Termination Notification
  • Utilization Management Guidelines
to access these downloads now. If you are a SELECT Health Network Provider and do not have a password, please contact us at 574-283-5959.

MDWise
MDwise Information

MDwise web site: www.mdwise.org

MDwise Provider Forms:
MDwise Behavioral Health: Outpatient Treatment Request Form (OTR) - Download Now (pdf format, 119Kb, posted Nov 2008)