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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 IHCPJuly 1, 20237.0
Interactive Voice Response SystemMay 24, 2023N/A
Prior AuthorizationJuly 1, 20237.0
Provider and Member Utilization ReviewSept. 1, 20226.0
Provider EnrollmentSept. 1, 20236.0
Provider Healthcare PortalJuly 1, 20237.0
Eligibility and Benefits Modules
Member Eligibility and Benefit CoverageMarch 1, 20237.0
Presumptive EligibilityFeb. 1, 20237.0
Right Choices ProgramJuly 1, 20236.0
Claims and Billing Procedures Modules
Claim Submission and ProcessingApril 1, 20237.0
Claim AdjustmentsJan. 1, 20247.0
Claim Administrative Review and AppealsDec. 1, 20216.0
Electronic Data InterchangeMarch 1, 20237.0
Financial Transactions and Remittance AdviceDec. 1, 20216.0
National Correct Coding InitiativeJune 1, 20226.0
Third-Party LiabilityJan. 1, 20226.1
Service- and Provider-Specific Modules
Anesthesia ServicesJune 1, 20226.0
Behavioral Health ServicesJuly 1, 20213.0
Chiropractic ServicesFeb. 1, 20237.0
Clinical TrialsMarch 1, 20235.0
Dental ServicesJuly 1, 20216.0
Diabetes Self-Management Training ServicesJune 1, 20226.0
Durable and Home Medical Equipment and SuppliesJune 1, 20225.0
Early and Periodic Screening, Diagnostic and Treatment (EPSDT) ServicesDec. 1, 20226.0
Emergency ServicesJan. 1, 20247.0
Evaluation and Management ServicesFeb. 1, 20237.0
Family Planning ServicesOct. 1, 20237.0
Federally Qualified Health Centers and Rural Health ClinicsJan. 1, 20226.0
Genetic TestingJan. 1, 20236.0
Hearing ServicesJune 1, 20237.0
Home- and Community-Based Services Billing GuidelinesJuly 1, 20226.0
Home Health ServicesSept. 1, 20237.0
Hospice ServicesJuly 1, 20226.0
Hospital Assessment FeeJan. 1, 20237.0
Injections, Vaccines and Other Physician-Administered DrugsJan. 1, 20237.0
Inpatient Hospital ServicesJuly 1, 20226.0
Laboratory ServicesFeb. 1, 20237.0
Long-Term CareJan. 1, 20236.0
Medical Practitioner ReimbursementJuly, 1, 20224.0
Obstetrical and Gynecological ServicesSept. 1, 20226.0
Oncology ServicesJul. 1, 20224.0
Out-of-State ProvidersNov. 1, 20237.0
Outpatient Facility ServicesApril 1, 20226.0
Pharmacy ServicesJan. 1, 20237.0
Podiatry ServicesNov. 1, 20237.0
Radiology ServicesMarch 1, 20226.0
Renal Dialysis ServicesOct. 1, 20237.0
School Corporation ServicesJuly 1, 20237.0
Surgical ServicesApril 1, 20226.0
Telehealth and Virtual ServicesNov. 1, 20236.0
Therapy ServicesApril 1, 20226.0
Transportation ServicesOct. 1, 20225.1
Vision ServicesSept. 1, 20237.0
Program-Specific Modules
590 ProgramSept. 1, 20237.0
Division of Aging
Home- and Community-Based Services Waivers
Jan. 1, 20237.0
Division of Disability and Rehabilitative Services
Home- and Community-Based Services Waivers
June 1, 202310.0
Division of Mental Health and Addiction
Adult Mental Health Habilitation Services
Oct. 1, 20237.0
Division of Mental Health and Addiction
Behavioral and Primary Healthcare Coordination Service
July 1, 20239.0
Division of Mental Health and Addiction
Child Mental Health Wraparound Services
June 1, 20226.0
Family Planning Eligibility ProgramOct. 1, 20237.0
Healthy Indiana PlanNov. 1, 20224.0
Medicaid Rehabilitation Option ServicesSept. 1, 20236.0

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

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