Note: This page provides information about professional, institutional and dental claims under the fee-for-service (FFS) delivery system. For pharmacy claims, refer to the member's pharmacy benefit manager. For services provided under the managed care delivery system, refer to managed care entity with which the member is enrolled.
The Indiana Health Coverage Programs (IHCP) offers these tips for making claim processing go as smoothly as possible.
Submit Claims Electronically!
Fee-for-service professional, institutional and dental claims can be submitted electronically – either online, using the IHCP Provider Healthcare Portal (Portal), or via batch file transmission, using the Health Insurance Portability and Accountability Act (HIPAA) 837 electronic claim transactions.
Electronic claims process in one-third the time required for paper claims. Electronic submissions also reduce errors, prevent unnecessary claim denials, increase cash flow and decrease costs. Electronic claim processing is:
- Faster – Most electronically submitted claims process in one to two weeks, compared to paper claims, which typically process in 30 days. If you use the Portal to submit your claims, they are adjudicated immediately. Electronic submissions are automatically read by system edits. When a clean claim is submitted by close of day Wednesday, you can look for final processing by Tuesday of the following week.
- Easier – You can easily submit all FFS nonpharmacy claims, including attachments, using the Portal. The Portal also allows easy resubmission of claims. (For electronic submissions submitted via 837 electronic transaction, attachments must continue to be submitted by mail.)
- More accurate – Electronic claims help reduce keying errors. In addition, claims submitted on paper are often handwritten, which makes them less clear and harder to read. Electronic submission eliminates these problems.
- Less expensive – With electronic claim submission, provider staff members no longer spend time printing and mailing forms – a costly process.
Electronic submission is the easiest, most accurate and least expensive way to submit claims. For more information about submitting electronic claims through the Portal, see:
- The Provider Healthcare Portal provider reference module
- Web-based training on the Provider Healthcare Portal Training page
- The Provider Healthcare Portal itself, where online help guides you through the claim-submission process
For information about submitting electronic claims via batch files (using HIPAA 837 transactions), see the Electronic Data Interchange (EDI) Solutions page.
Follow These General Tips
Follow these general tips for successful claim submission:
- Include valid IHCP Member IDs (also known as RIDs) with all claims.
- Be sure to include a valid National Provider Identifier (NPI) that is registered with the IHCP with all claim types (except in the case of atypical providers, such as waiver providers). Also check that the NPI entered on the claim is correct – that you have not transposed or omitted numbers, or made other errors.
- Be sure primary, secondary and tertiary carrier information is placed in the proper rows (A, B or C) in fields 50–55 on institutional (UB-04) claims. The carrier name should be entered in the following order in field 50, starting at row A and using the next available row for each additional carrier:
- Medicare or Medicare Advantage Plan
- Third-party liability (TPL), including Medicare supplement and other commercial insurance
- Medicaid or 590 Program
- Submit proper invoices for manual pricing on non-check adjustments.
- When you submit adjustment forms with check-related adjustments, be sure to submit all required information – Claim IDs/internal control numbers (ICNs), Member IDs, dates of service and procedure codes. The more information you include, the more quickly the IHCP can process the adjustment.
- Make sure handwritten paper claims are legible, and those that require signatures include full signatures and NOT JUST initials.
- DO NOT use red ink; it disappears when claims are scanned.
Applicable information for each carrier should then be entered in the corresponding row in fields 51 (Medicare and TPL only), 54 (Medicare and TPL only) and 55 (Medicaid/590 Program only).
Use Claim Notes Appropriately
Remember – if you submit claim notes with 837 transactions or via the Portal, the IHCP does not accept all types of claim notes as documentation. For details about when to submit claim notes to the IHCP, see the Claim Submission and Processing provider reference module.
Follow Guidelines for DME Cost Invoices
The IHCP requires invoices for Healthcare Common Procedure Coding System (HCPCS) codes for durable medical equipment (DME), supplies and hearing aids that are not manually priced. The following are considered acceptable documentation of the manufacturer's suggested retail price (MSRP):
- Manufacturer's invoice showing MSRP, suggested retail price or retail price
- Quote from the manufacturer showing the MSRP, suggested retail price or retail price
- Manufacturer's catalog page showing MSRP, suggested retail price or retail price (the publication date of the catalog must clearly show on the documentation)
- MSRP pricing from the manufacturer's website (the manufacturer's web address must be visible on printed documentation from its website)
For more information, see the Durable and Home Medical Equipment and Supplies provider reference module.