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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.


Module Keyword Search

Topical searches may be completed by entering a keyword or a “phrase”.  A list of modules containing the requested topic will appear. Selecting a module will present a link directly to the module where you will be able to search for exact content.


IHCP Provider Reference Modules

 Effective Date*Version
General Information Modules
Introduction to the IHCPSept. 1, 20216.0
Interactive Voice Response SystemDec. 1, 20216.0
Prior AuthorizationMarch 1, 20226.0
Provider and Member Utilization ReviewOct. 1, 20205.0
Provider EnrollmentNov. 1, 20205.0
Provider Healthcare PortalMay 1, 20226.0
Eligibility and Benefits Modules
Member Eligibility and Benefit CoverageOct. 1, 20216.0
Presumptive EligibilityJuly 1, 20216.0
Right Choices ProgramMay 1, 20214.0
Claims and Billing Procedures Modules
Claim Submission and ProcessingJuly 1, 20205.0
Claim AdjustmentsJune 1, 20216.0
Claim Administrative Review and AppealsDec. 1, 20216.0
Electronic Data InterchangeJune 1, 20216.0
Financial Transactions and Remittance AdviceDec. 1, 20216.0
National Correct Coding InitiativeJune 1, 20226.0
Third-Party LiabilityJune 1, 20205.0
Service- and Provider-Specific Modules
Anesthesia ServicesJune 1, 20226.0
Behavioral Health ServicesJuly 1, 20213.0
Chiropractic ServicesJuly 1, 20216.0
Clinical TrialsOct. 1, 20214.0
Dental ServicesJuly 1, 20216.0
Diabetes Self-Management Training ServicesJune 1, 20226.0
Durable and Home Medical Equipment and SuppliesDec. 1, 20204.0
Early and Periodic Screening, Diagnostic and Treatment (EPSDT)/HealthWatch ServicesMay 1, 20215.0
Emergency ServicesJan. 1, 20226.0
Evaluation and Management ServicesSept. 1, 20216.0
Family Planning ServicesJuly 14, 20226.0
Federally Qualified Health Centers and Rural Health ClinicsJan. 1, 20226.0
Genetic TestingMay 1, 20225.0
Hearing ServicesOct. 1, 20216.0
Home- and Community-Based Services Billing GuidelinesJuly 1, 20226.0
Home Health ServicesJan. 1, 20215.0
Hospice ServicesApril 1, 20215.0
Hospital Assessment FeeOct. 1, 20216.0
Injections, Vaccines and Other Physician-Administered DrugsJuly 1, 20216.0
Inpatient Hospital ServicesApril 1, 20215.0
Laboratory ServicesJuly 1, 20216.0
Long-Term CareJune 1, 20205.0
Medical Practitioner ReimbursementApril 1, 20213.0
Obstetrical and Gynecological ServicesOct. 1, 20205.0
Oncology ServicesJul. 1, 20224.0
Out-of-State ProvidersMay 1, 20226.0
Outpatient Facility ServicesApril 1, 20226.0
Pharmacy ServicesJune 1, 20216.0
Podiatry ServicesMay 1, 20226.0
Radiology ServicesMarch 1, 20226.0
Renal Dialysis ServicesMarch 1, 20226.0
School Corporation ServicesOct. 1, 20216.0
Surgical ServicesApril 1, 20226.0
Telehealth and Virtual ServicesJuly 1, 20225.0
Therapy ServicesOct. 1, 20205.0
Transportation ServicesMay 1, 20214.0
Vision ServicesApril 1, 20226.0
Program-Specific Modules
590 ProgramMarch 1, 20226.0
Division of Aging
Home- and Community-Based Services Waivers
July 1, 20206.0
Division of Disability and Rehabilitative Services
Home- and Community-Based Services Waivers
Jan. 1, 20229.1
Division of Mental Health and Addiction
Adult Mental Health Habilitation Services
Oct. 1, 20216.0
Division of Mental Health and Addiction
Behavioral and Primary Healthcare Coordination Service
July 28, 20228.0
Division of Mental Health and Addiction
Child Mental Health Wraparound Services
Nov. 1, 20205.0
Family Planning Eligibility ProgramJan. 1, 20226.0
Healthy Indiana PlanMay 1, 20213.0
Medicaid Rehabilitation Option ServicesJuly 1, 20214.0

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

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