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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.

 Effective Date*Version
General Information Modules
Introduction to the IHCPJuly 1, 20205.0
Interactive Voice Response SystemNovember 1, 20205.0
Prior AuthorizationDecember 1, 20205.0
Provider and Member Utilization ReviewOctober 1, 20205.0
Provider EnrollmentNovember 1, 20205.0
Provider Healthcare PortalJanuary 1, 20215.0
Eligibility and Benefits Modules
Member Eligibility and Benefit CoverageSeptember 1, 20205.0
Presumptive EligibilityJune 1, 20205.0
Right Choices ProgramMay 1, 20203.0
Claims and Billing Procedures Modules
Claim Submission and ProcessingJuly 1, 20205.0
Claim AdjustmentsApril 1, 20205.0
Claim Administrative Review and AppealsNovember 1, 20205.1
Electronic Data InterchangeApril 1, 20205.0
Financial Transactions and Remittance AdviceNovember 1, 20205.0
National Correct Coding InitiativeFebruary 1, 20215.0
Third-Party LiabilityJune 1, 20205.0
Service- and Provider-Specific Modules
Anesthesia ServicesFebruary 1, 20215.0
Chiropractic ServicesJuly 1, 20216.0
Clinical TrialsSeptember 1, 20203.0
Dental ServicesJune 1, 20205.0
Diabetes Self-Management Training ServicesApril 1, 20215.0
Durable and Home Medical Equipment and SuppliesDecember 1, 20204.0
Early and Periodic Screening, Diagnostic, and Treatment (EPSDT)/HealthWatch ServicesMay 1, 20215.0
Emergency ServicesSeptember 1, 20205.0
Evaluation and Management ServicesAugust 1, 20205.1
Family Planning ServicesOctober 1, 20205.0
Federally Qualified Health Centers and Rural Health ClinicsOctober 1, 20205.0
Genetic TestingDecember 1, 20204.0
Hearing ServicesAugust 1, 20205.0
Home and Community-Based Services Billing GuidelinesApril 1, 20215.0
Home Health ServicesJanuary 1, 20215.0
Hospice ServicesMarch 1, 20204.0
Hospital Assessment FeeSeptember 1, 20205.0
Injections, Vaccines, and Other Physician-Administered DrugsJuly 1, 20205.0
Inpatient Hospital ServicesMarch 1, 20204.0
Laboratory ServicesJuly 1, 20216.0
Long-Term CareJune 1, 20205.0
Medical Practitioner ReimbursementOctober 1, 20172.0
Mental Health and Addiction ServicesMay 1, 20172.0
Obstetrical and Gynecological ServicesOctober 1, 20205.0
Oncology ServicesFebruary 1, 20213.0
Out-of-State ProvidersJanuary 1, 20215.0
Outpatient Facility ServicesAugust 1, 20205.0
Pharmacy ServicesJune 1, 20216.0
Podiatry ServicesFebruary 1, 20215.0
Radiology ServicesDecember 1, 20205.0
Renal Dialysis ServicesDecember 1, 20205.0
School Corporation ServicesAugust 1, 20205.0
Surgical ServicesJanuary 1, 20215.0
Telemedicine and Telehealth ServicesOctober 1, 20194.1
Therapy ServicesOctober 1, 20205.0
Transportation ServicesOctober 1, 20183.0
Vision ServicesJanuary 1, 20215.0
Program-Specific Modules
590 ProgramNovember 1, 20205.0
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
July 16, 20208.0
Division of Mental Health and Addiction
Adult Mental Health Habilitation Services
April 1, 20205.0
Division of Mental Health and Addiction
Behavioral and Primary Healthcare Coordination Service
October 1, 20207.0
Division of Mental Health and Addiction
Child Mental Health Wraparound Services
November 1, 20205.0
Family Planning Eligibility ProgramOctober 1, 20205.0
Healthy Indiana PlanJuly 1, 20192.0
Medicaid Rehabilitation Option ServicesSeptember 1, 20183.0

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

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