The Medical Review Team (MRT) determines an applicant's eligibility for Indiana Medicaid based on a disability. Eligibility determinations are based on medical information requested by the MRT. Providers rendering the services necessary to provide this medical information, such as medical exams, medical tests, or record copying, are reimbursed for these services in accordance with an established fee schedule.
The Division of Family Resources (DFR) is responsible for determining initial and continuing eligibility for Medicaid disability. To meet the disability requirement, a person must have a significant impairment that is expected to last a minimum of 12 months. The MRT makes this determination and notifies the DFR of its decision.
Providers must be enrolled with the Indiana Health Coverage Programs (IHCP) and specifically identified as MRT providers to be reimbursed for MRT services. Nonlicensed providers are eligible to enroll as MRT providers for reimbursement of medical records copying only. To complete the enrollment process for the MRT program, prospective providers must enroll with the IHCP through the Provider Healthcare Portal or complete an IHCP provider enrollment application and check the appropriate box under Other IHCP Program Participation.
For more information, see the Member Eligibility and Benefit Coverage provider reference module.