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FAQs – Top 10 Questions

Persons interested in applying for Medicaid should review the information provided on the Indiana Medicaid for Members website or the Division of Family Resources website.

Healthcare practitioners, facilities and other providers interested in enrolling with the Indiana Health Coverage Programs (IHCP) can submit applications online through the IHCP Provider Healthcare Portal (IHCP Portal) or by mail, using the appropriate provider enrollment packet. For more information, see the Complete an IHCP Provider Enrollment Application page on this website.

Updates to the provider information on file can be made online (through a registered IHCP Portal account) or by mail. Please follow the instructions on the Update Your Provider Profile page of this website.

For service-, provider- or benefit-specific coding information, refer to the relevant IHCP provider reference modules and code table documents. See the Claim Submission and Processing provider reference module to view general requirements for billing a claim to the IHCP. Changes to policies and procedures that occur after the effective date noted for each module are announced in IHCP Bulletins. If you have additional questions, please contact your Provider Relations consultant.

Note: For members enrolled in a managed care program (such as Healthy Indiana Plan, Hoosier Care Connect, Hoosier Healthwise or Indiana PathWays for Aging [PathWays]), contact the member’s managed care organization (MCO) for billing and coding guidelines. See the IHCP Quick Reference Guide for contact information.

IHCP providers can verify a member’s eligibility (IHCP enrollment status, benefit plan assignment and so on) using one of three methods, as described in the Member Eligibility and Benefit Coverage provider reference module:
  • IHCP Provider Healthcare Portal
  • 270/271 Eligibility Benefit Inquiry and Response electronic transactions using approved vendor software
  • Virtual assistant (GABBY) at 800-457-4584 (option 2)

  • Providers that bill services on the professional claim (CMS-1500 claim form or electronic equivalent) or the dental claim (ADA 2012 claim form or electronic equivalent) can use the Professional Fee Schedule to determine IHCP-covered services.
  • Providers that bill outpatient services on the institutional claim (UB-04 or electronic equivalent) can use the Outpatient Fee Schedule to determine IHCP-covered services.
  • For information about inpatient service coverage, see the Inpatient Hospital Services provider reference module.
  • Information for pharmacy billers is in the Pharmacy Services provider reference module.

Note: Individual coverage for a particular service varies by benefit plan assignment, among other factors. Not all IHCP members are eligible for full Medicaid benefits; see the Member Eligibility and Benefit Coverage provider reference module for details.

The 999 Functional Acknowledgement provides trading partners with verification that claims submitted electronically have been accepted for processing. The 999 also identifies any claims rejected because of Health Insurance Portability and Accountability Act (HIPAA) compliance violations. The 999 is available for download immediately after the claim file is submitted. Contact your claim-submission software vendor for more details.

Processed claims and claim adjustments appear on the provider’s weekly remittance advice (RA) or 835 electronic transaction. Additionally, providers (and their delegated representatives) can use the IHCP Provider Healthcare Portal to check the status of a claim or claim adjustment at any time. For claims and claim adjustments submitted by mail, please allow at least 45 days after submission before calling Customer Assistance to inquire about the status of the claim or adjustment. See the Claim Submission and Processing and Claim Adjustments provider reference modules for more information.

Note: This answer pertains to fee-for-service claims. For claims submitted to an MCO, follow the MCO's procedures for checking the status of the claim or claim adjustment.

Instructions on how to become a Health Insurance Portability and Accountability Act (HIPAA) trading partner are available from the Electronic Data Interchange (EDI) Solutions page of this website.

HIPAA refers to the Health Insurance Portability and Accountability Act. Please read the HIPAA information available on this website.