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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.


Topical searches across all modules may be completed by entering a word or phrase in the box below and clicking the search button. You will be taken to a new page that lists all modules containing the requested term(s). You can also choose to include IHCP Bulletins and/or Banner Pages (from 2020 to present) in your search results.

IHCP Provider Reference Modules

  Effective Date*Version
General Information Modules
Introduction to the IHCP July 1, 2023 7.0
Prior Authorization July 1, 2023 7.0
Provider and Member Utilization Review Sept. 1, 2023 7.0
Provider Enrollment Sept. 1, 2023 6.0
Provider Healthcare Portal July 1, 2023 7.0
Eligibility and Benefits Modules
Member Eligibility and Benefit Coverage March 1, 2023 7.0
Presumptive Eligibility Feb. 1, 2023 7.0
Right Choices Program July 1, 2023 6.0
Claims and Billing Procedures Modules
Claim Submission and Processing April 1, 2023 7.0
Claim Adjustments Jan. 1, 2024 7.0
Claim Administrative Review and Appeals Dec. 1, 2021 6.0
Electronic Data Interchange March 1, 2023 7.0
Financial Transactions and Remittance Advice Dec. 1, 2021 6.0
National Correct Coding Initiative June 1, 2022 6.0
Third-Party Liability Jan. 1, 2022 6.1
Service- and Provider-Specific Modules
Anesthesia Services March 1, 2024 7.0
Behavioral Health Services July 1, 2021 3.0
Chiropractic Services Feb. 1, 2023 7.0
Clinical Trials March 1, 2023 5.0
Dental Services Sept. 15, 2023 7.0
Diabetes Self-Management Training Services June 1, 2022 6.0
Durable and Home Medical Equipment and Supplies Nov. 20, 2023 6.0
Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Services Dec. 1, 2022 6.0
Emergency Services Jan. 1, 2024 7.0
Evaluation and Management Services Feb. 1, 2023 7.0
Family Planning Services Oct. 1, 2023 7.0
Federally Qualified Health Centers and Rural Health Clinics Oct. 1, 2023 7.0
Genetic Testing Jan. 1, 2023 6.0
Hearing Services June 1, 2023 7.0
Home- and Community-Based Services Billing Guidelines July 1, 20247.0
Home Health Services Sept. 1, 2023 7.0
Hospice Services July 1, 20247.0
Hospital Assessment Fee Jan. 1, 2023 7.0
Injections, Vaccines and Other Physician-Administered Drugs Jan. 1, 2023 7.0
Inpatient Hospital Services July 1, 2022 6.0
Laboratory Services Feb. 1, 2023 7.0
Long-Term Care July 1, 20247.0
Medical Practitioner Reimbursement July, 1, 2022 4.0
Obstetrical and Gynecological Services Jan. 1, 2024 7.0
Oncology Services Jul. 1, 2022 4.0
Out-of-State Providers Nov. 1, 2023 7.0
Outpatient Facility Services Jan. 1, 2024 7.0
Pharmacy Services Jan. 1, 2023 7.0
Podiatry Services Nov. 1, 2023 7.0
Radiology Services March 1, 2024 7.0
Renal Dialysis Services Oct. 1, 2023 7.0
School Corporation Services July 1, 2023 7.0
Surgical Services April 1, 2022 6.0
Telehealth and Virtual Services Nov. 1, 2023 6.0
Therapy Services April 1, 2022 6.0
Transportation Services Oct. 1, 2022 5.1
Vision Services Sept. 1, 2023 7.0
Program-Specific Modules
590 Program Sept. 1, 2023 7.0
Family Planning Eligibility Program Oct. 1, 2023 7.0
Healthy Indiana Plan Nov. 1, 2022 4.0
Medicaid Rehabilitation Option Services Sept. 1, 2023 6.0
Program-Specific Modules – Home- and Community-Based Services
Division of Mental Health and Addiction
Adult Mental Health Habilitation Services
Oct. 1, 2023 7.0
Division of Mental Health and Addiction
Behavioral and Primary Healthcare Coordination Service
July 1, 2023 9.0
Division of Mental Health and Addiction
Child Mental Health Wraparound Services
Dec. 7, 2023 7.0
Division of Disability and Rehabilitative Services
Home- and Community-Based Services Waivers

(Community Integration and Habilitation, Family Supports, Health and Wellness, Traumatic Brain Injury) 
July 1, 2024 11.0
Office of Medicaid Policy and Planning
Home-  and Community-Based Services Waiver: Indiana PathWays for Aging
July 1, 2024 1.0

* Note: The effective date indicates the date of the policies and procedures included in this version of the module

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