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Eligibility Verification

It is important that you verify member eligibility on the date of service every time you provide services. Viewing a member's ID card alone does not ensure member eligibility, and neither does having prior authorization on file.

The Indiana Health Coverage Programs (IHCP) historically has provided the same card for all members regardless of the specific IHCP program in which they enrolled. With the implementation of managed care programs, the managed care entities (MCEs) have begun issuing cards for their enrolled members. MCE cards will be issued as new members enroll in the plan or as lost cards are replaced; therefore, some managed care members will continue to carry the generic IHCP member card. Although MCE cards will have a new look, they will continue to include the member's IHCP Member ID (or RID) for eligibility verification purposes. See the Member Eligibility and Benefit Coverage provider reference module for more information.

If you fail to verify eligibility on the date of service, you risk claim denial if, for example, the member was not eligible on the date of service, or the service provided was outside the member's scope of coverage.

The following eligibility verification tools can be used to verify the status of a member's eligibility for current and past dates of service.

IHCP Provider Healthcare Portal

The IHCP Provider Healthcare Portal is a secure website that allows you to perform multiple functions including obtaining eligibility information and filing fee-for-service (FFS) claims. The Portal is fast and easy to use, and online help is available through the eligibility verification process. For more information, see the Provider Healthcare Portal provider reference module.

Interactive Voice Response (IVR) System

The Interactive Voice Response (IVR) System enables you to obtain member eligibility, basic FFS claim status, and other routine information through the use of a touch-tone telephone. For instructions about how to use IVR System, see the Interactive Voice Response System provider reference module.

270/271 Eligibility Inquiry and Response Transaction - Batch or Interactive

The 270/271 eligibility benefit request and response is a Health Insurance Portability and Accountability Act (HIPAA)-compliant electronic transaction for use by registered trading partners. For more information about electronic transactions, see EDI Solutions web page.

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