Language Translation
Provider Enrollment Provider Enrollment
Provider References Provider References
Provider Education Provider Education
Business Transactions Business Transactions
Clinical Services Clinical Services
About IHCP Programs About IHCP Programs
  Close Menu

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 bulletins.


Search References

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 terms. You can also choose to include IHCP bulletins (from 2020 to present) and/or banner pages (from 2020 through June 2023) in your search results.

View Modules

  Effective Date of
Policies and Procedures
Version
General Information Modules
Introduction to the IHCP Jan. 1, 2025 8.0
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 7.1
Eligibility and Benefits Modules
Member Eligibility and Benefit Coverage Oct. 1, 2024 8.0
Presumptive Eligibility Feb. 1, 2023 7.0
Right Choices Program Jan. 1, 20257.0
Claims and Billing Procedures Modules
Claim Submission and Processing July 1, 2024 8.1
Claim Adjustments Jan. 1, 2024 7.1
Claim Administrative Review and Appeals Oct. 1, 2024 7.0
Electronic Data Interchange Jan. 1, 2025 8.0
Financial Transactions and Remittance Advice Aug. 1, 2024 7.0
National Correct Coding Initiative Sept. 1, 2024 7.0
Third-Party Liability Aug. 1, 2024 7.0
Service- and Provider-Specific Modules
Anesthesia Services March 1, 2024 7.0
Behavioral Health Services Aug. 1, 2023 4.1
Chiropractic Services Feb. 1, 2023 7.0
Clinical Trials March 1, 2023 5.0
Dental Services Sept. 15, 2023 7.2
Diabetes Self-Management Training Services Sept. 1, 2024 7.0
Durable and Home Medical Equipment and Supplies Nov. 20, 2023 6.0
Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Services Oct. 1, 2024 7.0
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, 2024 7.0
Home Health Services Sept. 1, 2023 7.0
Hospice Services July 1, 2024 7.1
Hospital Assessment Fee Jan. 1, 2023 7.1
Injections, Vaccines and Other Physician-Administered Drugs Jan. 1, 2023 7.0
Inpatient Hospital Services Jan. 1, 2024 7.2
Laboratory Services Feb. 1, 2023 7.0
Long-Term Care July 1, 2024 7.1
Medical Practitioner Reimbursement July, 1, 2022 4.0
Obstetrical and Gynecological Services Jan. 1, 2024 7.0
Oncology Services Sept. 1, 2024 5.1
Out-of-State Providers Nov. 1, 2023 7.0
Outpatient Facility Services Jan. 1, 2024 7.1
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 7.1
School Corporation Services Jan. 1, 2025 8.0
Surgical Services Sept. 1, 2024 7.0
Telehealth and Virtual Services Nov. 1, 2023 6.1
Therapy Services July 1, 2024 7.0
Transportation Services Sept. 1, 2023 6.0
Vision Services Sept. 1, 2023 7.0
Program-Specific Modules
590 Program Feb. 1, 2025 8.0
Family Planning Eligibility Program Oct. 1, 2023 7.0
Healthy Indiana Plan Oct. 1, 2024 5.0
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
May 1, 2025 9.0
Division of Mental Health and Addiction
Behavioral and Primary Healthcare Coordination Service
June 1, 2025 11.0
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 11.3
Office of Medicaid Policy and Planning
Home-  and Community-Based Services Waiver: Indiana PathWays for Aging
July 1, 2024 1.3

Provider News & Events

See More