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Best Practices for Claim Submission

Note: This page provides information about professional, institutional and dental claims under the fee-for-service (FFS) delivery system.

For pharmacy claims, refer to the member's pharmacy benefit manager. For services provided under the managed care delivery system, refer to the managed care entity with which the member is enrolled. See the IHCP Quick Reference Guide for contact information.

The Indiana Health Coverage Programs (IHCP) offers these tips for making claim processing go as smoothly as possible.

Submit Claims Electronically

Fee-for-service professional, institutional and dental claims can be submitted electronically – either online, using the IHCP Provider Healthcare Portal (IHCP Portal), or via batch file transmission, using the Health Insurance Portability and Accountability Act (HIPAA) 837 electronic claim transactions.

Electronic claims process in one-third the time required for paper claims. Electronic submissions also reduce errors, prevent unnecessary claim denials, increase cash flow and decrease costs. Electronic claim processing is:

  • Faster – Most electronically submitted claims process in one to two weeks, compared to paper claims, which typically process in 30 days. If you use the IHCP Portal to submit your claims, they are adjudicated immediately. Electronic submissions are automatically read by system edits. When a clean claim is submitted by close of day Wednesday, you can look for final processing by Tuesday of the following week.
  • Easier – You can easily submit all FFS nonpharmacy claims, including attachments, using the IHCP Portal. The IHCP Portal also allows easy resubmission of claims. (For electronic submissions submitted via 837 electronic transaction, attachments must continue to be submitted by mail.)
  • More accurate – Electronic claims help reduce keying errors. In addition, claims submitted on paper are often handwritten, which makes them less clear and harder to read. Electronic submission eliminates these problems.
  • Less expensive – With electronic claim submission, provider staff members no longer spend time printing and mailing forms – a costly process.

Electronic submission is the easiest, most accurate and least expensive way to submit claims. For more information about submitting electronic claims through the IHCP Portal, see:

For information about submitting electronic claims via batch files (using HIPAA 837 transactions), see the Electronic Data Interchange (EDI) Solutions page.

Follow These General Tips

Follow these general tips for successful claim submission:

  • Include valid IHCP Member IDs (also known as RIDs) with all claims.
  • Be sure to include a valid National Provider Identifier (NPI) that is registered with the IHCP with all claim types (except in the case of atypical providers, such as waiver providers). Also check that the NPI entered on the claim is correct – that you have not transposed or omitted numbers, or made other errors.
  • On institutional paper claims (UB-04), be sure primary, secondary and tertiary carrier information is placed in the proper rows (A, B or C) in fields 50–55. The carrier name should be entered in the following order in field 50, starting at row A and using the next available row for each additional carrier:
    • Medicare or Medicare Advantage Plan
    • Commercial insurance, including Medicare supplement
    • Medicaid or 590 Program

    • Applicable information for each carrier should then be entered in the corresponding row in fields 51 (Medicare and commercial only), 54 (Medicare and commercial only) and 55 (Medicaid/590 Program only).

  • Include all required attachments.
  • Make sure paper claims are legible:
    • Avoid handwriting information unless directed to do so; instead, type information using Arial, Helvetica, Times New Roman or Courier font with 10- to 14-point font size.
    • Use only black or blue ink.
    • Where signatures are required, include full signatures, NOT JUST initials.

Here are a few tips specific to submitting claim adjustments:

  • Submit proper invoices for manual pricing on non-check adjustments.
  • When you submit adjustment forms with check-related adjustments, be sure to submit all required information:
    • Claim IDs/internal control numbers (ICNs)
    • Member IDs
    • Dates of service
    • Procedure codes

    • The more information you include, the more quickly the IHCP can process the adjustment. See the Claim Adjustments module for more information.

Use Claim Notes Appropriately

Remember – if you submit claim notes with 837 transactions or via the IHCP Portal, the IHCP does not accept all types of claim notes as documentation. For details about when to submit claim notes to the IHCP, see the Claim Submission and Processing provider reference module.

Include Appropriate Documentation for Manually Priced DME Codes

For durable medical equipment (DME), medical supply and hearing aid procedure codes that do not have an established rate on the Medicare fee schedule, a rate may be established using acquisition cost information. Claims for these manually priced codes require documentation of the manufacturer's suggested retail price (MSRP) – or the cost invoice, if no MSRP is available. Reimbursement for these codes is set at 75% of the MSRP (or, if no MSRP is available, the provider's cost plus 20%).

The following are considered acceptable documentation of the MSRP:

  • Manufacturer's invoice showing MSRP, suggested retail price or retail price
  • Quote from the manufacturer showing the MSRP, suggested retail price or retail price
  • Manufacturer's catalog page showing MSRP, suggested retail price or retail price (the publication date of the catalog must clearly show on the documentation)
  • MSRP pricing from the manufacturer's website (the manufacturer's web address must be visible on printed documentation from its website)

If the item has no MSRP, the provider should submit a cost invoice with the following notation: "MSRP is not available for the product billed."

Note: The MSRP or cost invoice must be the most current MSRP or cost invoice, and can be no older than two years old.

For more information, see the Durable and Home Medical Equipment and Supplies provider reference module.

Include All Required TPL Information

Information about other insurance, known as third-party liability (TPL) must be included as described in the Third-Party Liability module. For certain types of claims, if the claim is submitted on paper rather than electronically, the IHCP TPL/Medicare Special Attachment Form must be included with all required information properly completed.

For guidance on completing this form, see the Quick Reference Guide: IHCP TPL/Medicare Special Attachment Form.

Do Not Include Attachments With Unnecessary Protected Health Information

Claim attachments should be submitted only for the information required to process claims. The following items should not be submitted:

  • Photocopies of members' credit card information
  • Third-party explanations of benefits (EOBs) with other member information not redacted
  • Photocopies of checks

Learn More About Claim Submission

For more detailed information about submitting claims, see the Claim Submission and Processing, Provider Healthcare Portal and Electronic Data Interchange provider reference modules.

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