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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 August 1, 2019 4.0
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 March 1, 2019 4.0
Right Choices Program October 1, 2017 2.0
Claims and Billing Procedures Modules
Claim Submission and Processing July 1, 2019 4.0
Claim Adjustments March 1, 2019 4.0
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 April 1, 2019 4.0
Service- and Provider-Specific Modules
Anesthesia Services September 1, 2018 3.0
Chiropractic Services July 1, 2019 4.0
Clinical Trials December 1, 2019 2.0
Dental Services April 1, 2019 4.0
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 October 1, 2019 4.0
Evaluation and Management Services August 1, 2019 4.0
Family Planning Services December 1, 2019 4.0
Federally Qualified Health Centers and Rural Health Clinics October 1, 2019 4.0
Genetic Testing June 1, 2018 3.0
Hearing Services August 1, 2019 4.0
Home and Community-Based Services Billing Guidelines February 1, 2020 4.0
Home Health Services December 1, 2019 4.0
Hospice Services January 1, 2019 3.0
Hospital Assessment Fee April 1, 2019 4.0
Injections, Vaccines, and Other Physician-Administered Drugs July 1, 2019 4.0
Inpatient Hospital Services March 1, 2020 4.0
Laboratory Services July 1, 2019 4.0
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 February 1, 2020 4.0
Oncology Services February 1, 2020 2.0
Out-of-State Providers February 1, 2020 4.0
Outpatient Facility Services August 1, 2019 4.0
Pharmacy Services March 1, 2019 4.0
Podiatry Services November 1, 2018 3.0
Radiology Services February 7, 2020 4.0
Renal Dialysis Services January 1, 2020 4.0
School Corporation Services November 1, 2019 4.0
Surgical Services May 1, 2018 3.0
Telemedicine and Telehealth Services October 1, 2019 4.0
Therapy Services April 1, 2017 2.0
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
April 1, 2017 5.0
Division of Disability and Rehabilitative Services
Home and Community-Based Services Waivers
July 1, 2019 7.0
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 Services
July 1, 2019 6.0
Division of Mental Health and Addiction
Child Mental Health Wraparound Services
July 1, 2019 4.0
Family Planning Eligibility Program July 1, 2018 3.0
Healthy Indiana Plan February 1, 2015 1.0
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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