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.

• Jump to Eligibility and Benefits Modules
• Jump to Claims and Billing Procedures Modules
• Jump to Service- and Provider-Specific Modules
• Jump to Program-Specific Modules

	Effective Date*	Version
General Information Modules
Introduction to the IHCP	August 1, 2019	4.0
Interactive Voice Response System	October 1, 2018	3.0
Prior Authorization	February 1, 2018	3.0
Provider and Member Utilization Review	March 1, 2018	3.0
Provider Enrollment	March 1, 2019	4.0
Provider Healthcare Portal	March 1, 2018	3.0
Eligibility and Benefits Modules
Member Eligibility and Benefit Coverage	March 1, 2018	3.0
Presumptive Eligibility	March 1, 2019	4.0
Right Choices Program	October 1, 2017	2.0
Claims and Billing Procedures Modules
Claim Submission and Processing	April 1, 2018	3.0
Claim Adjustments	March 1, 2019	4.0
Claim Administrative Review and Appeals	August 22, 2019	3.0
Electronic Data Interchange	March 1, 2019	4.0
Financial Transactions and Remittance Advice	October 1, 2018	3.0
National Correct Coding Initiative	November 1, 2018	3.0
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	October 1, 2018	1.0
Dental Services	April 1, 2018	3.0
Diabetes Self-Management Training Services	July 1, 2018	3.0
Durable and Home Medical Equipment and Supplies	May 1, 2018	3.0
Early and Periodic Screening, Diagnosis, and Treatment (EPSDT)/HealthWatch	April 1, 2017	2.0
Emergency Services	August 1, 2018	3.0
Evaluation and Management Services	August 1, 2019	4.0
Family Planning Services	July 1, 2018	3.0
Federally Qualified Health Centers and Rural Health Clinics	August 1, 2018	3.0
Genetic Testing	June 1, 2018	3.0
Hearing Services	August 1, 2019	4.0
Home and Community-Based Services Billing Guidelines	November 1, 2018	3.0
Home Health Services	August 1, 2018	3.0
Hospice Services	January 1, 2019	3.0
Hospital Assessment Fee	April 1, 2019	4.0
Injections, Vaccines, and Other Physician-Administered Drugs	May 1, 2018	3.0
Inpatient Hospital Services	January 1, 2019	3.0
Laboratory Services	May 1, 2018	3.0
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	July 1, 2018	3.0
Oncology Services	November 1, 2018	1.0
Out-of-State Providers	January 1, 2019	3.0
Outpatient Facility Services	August 1, 2019	4.0
Pharmacy Services	March 1, 2019	4.0
Podiatry Services	November 1, 2018	3.0
Radiology Services	June 1, 2018	3.0
Renal Dialysis Services	September 1, 2018	3.0
School Corporation Services	November 1, 2019	4.0
Surgical Services	May 1, 2018	3.0
Telemedicine and Telehealth Services	January 1, 2019	3.0
Therapy Services	April 1, 2017	2.0
Transportation Services	October 1, 2018	3.0
Vision Services	August 1, 2018	3.0
Program-Specific Modules
590 Program	November 1, 2018	3.0
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	August 1, 2018	6.0
Division of Mental Health and Addiction Adult Mental Health Habilitation Services	July 1, 2019	4.0
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, 2018	3.0
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.