Indiana Provider Documents – Provider Partners Health Plans

PROVIDER SERVICES LINE

For all provider inquiries, please call 1-855-969-5907 (TTY users should call 711) Hours are 8:00 A.M. to 8:00 P.M., seven days a week from October 1 through March 31; 8:00 A.M. to 8:00 P.M. Monday to Friday from April 1 through September 30.

Provider Information

2025 Provider Manual
Participating Providers
Participating Pharmacies
Model of Care Training and Attestation
2025 Provider Quick Reference Guide (Indiana Advantage Plan)
2025 Provider Quick Reference Guide (Indiana Community Plan)
2025 Provider Quick Reference Guide (Indiana Essential Plan)
Provider Information Update
2025 Provider Coverage Determination Form

Medical Information and Authorization

2025 Authorization Form
2025 Authorization Form (Spanish)

Pharmacy Materials

Formulary 2025

2025 Comprehensive Formulary (Prescription Drugs)
(last updated 1/1/2025)
2025 Prior Authorization Criteria
(last updated 1/1/2025)
2025 Step Therapy Criteria
(last updated 1/1/2025)
2025 Formulary (Prescription Drugs) Search Tool
Online Part D Coverage Determination/Redetermination

Member Benefit Information

2025 Advantage Plan Summary of Benefits
(contains multi-language insert)
2025 Community Plan Summary of Benefits
(contains multi-language insert)
2025 Essential Plan Summary of Benefits
(contains multi-language insert)

Page Last Updated: 01/01/2025