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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 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.

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