Nonpharmacy Prior Authorization Attachment Address Table The following table provides the prior authorization (PA) address for each of the care management organizations (CMOs), as well as the Traditional Medicaid fee-for-service vendor address for submission of PA requests, PA updates, and PA attachments. Please note that PA requests for carved-out risk-based managed care (RBMC) services, hospice services, and Traditional Medicaid members, as well as PA requests for any other nonpharmacy services outside RBMC and Care Select, should be submitted to the following fee-for-service address noted for review. This table provides address information in a real-time format to ensure that providers have the most current address information for submission of these documents. The Quick Reference Guide on the Contact Us web page of indianamedicaid.com also contains PA submission addresses. The information in the following table supersedes any addresses listed in the Quick Reference Guide and should be used to ensure accurate mailings of PA information to the Indiana Health Coverage Programs (IHCP) Prior Authorization department in these organizations. The UMO ID column is for use on the Health Insurance Portability and Accountability Act (HIPAA) 278 transaction. If you submit a HIPAA 278 transaction, please use the correct UMO ID. Nonpharmacy Prior Authorization Attachment Address Table Report Date:  5/23/2013 6:39:42 AM Member's Current CMO Send PA Attachments To Toll Free Phone Fax Number UMO ID ADVANTAGE HEALTH SOLUTIONS INC ADVANTAGE HEALTH SOLUTIONS - CS ATTN: PRIOR AUTHORIZATION DEPT PO BOX 80068 INDIANAPOLIS, IN  46280 800-784-3981 800-689-2759 ADVCMO  MDWISE MDWISE, INC ATTN: PRIOR AUTHORIZATION DEPT PO BOX 44214 INDIANAPOLIS, IN  46244-0214 800-356-1204 877-822-7186 MDWCMO  FEE FOR SERVICE ADVANTAGE HEALTH SOLUTIONS-FFS ATTN: PRIOR AUTHORIZATION DEPT PO BOX 40789 INDIANAPOLIS, IN  46240 800-269-5720 800-689-2759 ADVFFS  Each provider is mailed a Prior Authorization decision letter, including an Indiana Medicaid Notice of Appeal Rights. The same letter is mailed to the member. This notification gives providers as well as members and families information about steps they can take to appeal the PA decision. To access a copy of the notification letter, please select one of the versions below. For Notice of Appeal Rights: (English) (Spanish) The Notice of Appeal Rights states that a member can download the following appeal form to file their appeal. For Medicaid Appeal Request Form click here.