Prior Authorization Attachment Address Table The following table provides the Prior Authorization (PA) address for each of the Care Management Organizations (CMO) as well as the Traditional Medicaid fee for service vendor address for submission of PA request, PA updates and PA attachments. Please note, that PA requests for carved out Risk Based Managed Care (RBMC) services, Medicaid Select, Hospice, and Traditional Medicaid members as well as any other PA requests for services outside of RBMC and Care Select should be submitted to the Fee For Service address noted below 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 that is available to the provider community in the Indiana Health Coverage Program (IHCP) monthly newsletter also contains PA document submission addresses. The information in the table below supersedes any addresses listed in the Quick Reference Guide and should be utilized to ensure accurate mailings of PA information to the IHCP Prior Authorization department within these organizations. The UMO ID column is for use on the HIPAA 278 transaction. If you submit a HIPAA 278 transaction please use the correct UMO ID. Prior Authorization Attachment Address Table Report Date:  5/17/2012 2:18:36 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  FEE FOR SERVICE ADVANTAGE HEALTH SOLUTIONS-FFS ATTN: PRIOR AUTHORIZATION DEPT PO BOX 40789 INDIANAPOLIS, IN  46240 800-269-5720 800-689-2759 ADVFFS  MDWISE MDWISE, INC ATTN: PRIOR AUTHORIZATION DEPT PO BOX 44214 INDIANAPOLIS, IN  46244-0214 866-440-2449 877-822-7186 MDWCMO  Each member is provided an Indiana Medicaid Notice of Appeal Rights with the Prior Authorization decision letter. This notification provides an explanation of the member’s appeal rights and how to file an appeal. To access a copy of the notification, 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.