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IHCP Provider Reference Modules

The Indiana Health Coverage Programs (IHCP) Provider Reference Modules are the primary reference for billing and reimbursement guidance for providers conducting business with the IHCP. Modules include instructions for submitting IHCP claims and prior authorization (PA) requests, as well as other related topics.

Changes to policies and procedures that occur after the effective date noted for each module are announced in IHCP provider Banner Pages and Bulletins.

  Effective Date* Version
General Information Modules
Introduction to the IHCP July 1, 2020 5.0
Interactive Voice Response System November 1, 2019 4.0
Prior Authorization December 1, 2019 4.0
Provider and Member Utilization Review October 1, 2019 4.0
Provider Enrollment March 1, 2019 4.0
Provider Healthcare Portal October 1, 2019 4.0
Eligibility and Benefits Modules
Member Eligibility and Benefit Coverage April 1, 2019 4.0
Presumptive Eligibility June 1, 2020 5.0
Right Choices Program May 1, 2020 3.0
Claims and Billing Procedures Modules
Claim Submission and Processing July 1, 2019 4.0
Claim Adjustments April 1, 2020 5.0
Claim Administrative Review and Appeals November 1, 2019 4.0
Electronic Data Interchange April 1, 2020 5.0
Financial Transactions and Remittance Advice November 1, 2019 4.0
National Correct Coding Initiative February 1, 2020 4.0
Third-Party Liability June 1, 2020 5.0
Service- and Provider-Specific Modules
Anesthesia Services October 1, 2019 4.0
Chiropractic Services June 1, 2020 5.0
Clinical Trials September 1, 2020 3.0
Dental Services June 1, 2020 5.0
Diabetes Self-Management Training Services March 1, 2020 4.0
Durable and Home Medical Equipment and Supplies May 1, 2018 3.0
Early and Periodic Screening, Diagnostic, and Treatment (EPSDT)/HealthWatch Services January 1, 2019 3.0
Emergency Services September 1, 2020 5.0
Evaluation and Management Services August 1, 2020 5.0
Family Planning Services October 1, 2020 5.0
Federally Qualified Health Centers and Rural Health Clinics October 1, 2020 5.0
Genetic Testing June 1, 2018 3.0
Hearing Services August 1, 2020 5.0
Home and Community-Based Services Billing Guidelines February 1, 2020 4.0
Home Health Services December 1, 2019 4.0
Hospice Services March 1, 2020 4.0
Hospital Assessment Fee September 1, 2020 5.0
Injections, Vaccines, and Other Physician-Administered Drugs July 1, 2020 5.0
Inpatient Hospital Services March 1, 2020 4.0
Laboratory Services June 1, 2020 5.0
Long-Term Care March 1, 2019 4.0
Medical Practitioner Reimbursement October 1, 2017 2.0
Mental Health and Addiction Services May 1, 2017 2.0
Obstetrical and Gynecological Services October 1, 2020 5.0
Oncology Services February 1, 2020 2.0
Out-of-State Providers February 1, 2020 4.0
Outpatient Facility Services August 1, 2020 5.0
Pharmacy Services July 1, 2020 5.0
Podiatry Services February 1, 2020 4.0
Radiology Services February 7, 2020 4.0
Renal Dialysis Services December 1, 2020 5.0
School Corporation Services August 1, 2020 5.0
Surgical Services August 1, 2019 4.0
Telemedicine and Telehealth Services October 1, 2019 4.0
Therapy Services October 1, 2020 5.0
Transportation Services October 1, 2018 3.0
Vision Services February 1, 2020 4.0
Program-Specific Modules
590 Program November 1, 2019 4.0
Division of Aging
Home and Community-Based Services Waivers
July 1, 2020 6.0
Division of Disability and Rehabilitative Services
Home and Community-Based Services Waivers
July 16, 2020 8.0
Division of Mental Health and Addiction
Adult Mental Health Habilitation Services
April 1, 2020 5.0
Division of Mental Health and Addiction
Behavioral and Primary Healthcare Coordination Service
October 1, 2020 7.0
Division of Mental Health and Addiction
Child Mental Health Wraparound Services
July 1, 2019 4.0
Family Planning Eligibility Program October 1, 2020 5.0
Healthy Indiana Plan July 1, 2019 2.0
Medicaid Rehabilitation Option Services September 1, 2018 3.0

*The effective date indicates the date of the policies and procedures included in this version of the module.

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