How It Works — MDHIN

How MDHIN Works

For Members

1. Pick your path — RxDirectCare (pharmacy) or MDDPC (physician).
2. Enroll online — year-round, instant eligibility.
3. Get care — same-day pharmacy visits via ConnectRxCare or scheduled physician care.
4. MDHIN adjudicates covered services as a payer. No copays or deductibles.

For Pharmacies (RxDirectCare)

  • Submit eligible encounters to MDHIN via BIN/PCN with MDHIN groups/tier codes.
  • Use MDHIN pseudo-NDC/service codes for visit types and POCT (A1c, lipid, strep, flu, etc.).
  • Payment flows per agreement to participating entities after adjudication.

For Providers (MDDPC)

  • Submit claims via 837/835 using the MDHIN payer code (or through ConnectHIN).
  • Use approved coding: 99202–99215, 99423; 99000 for POCT when applicable; include a unique Visit ID.
  • Use Modifier 25 when multiple services occur in one encounter.

Administration Platform

  • Real-time eligibility (E1/270/271 equivalent)
  • Member enrollment & onboarding
  • Automated statements, reporting, and compliance support