Individuals determined by the Social Security Administration to be disabled are considered disabled for Medicaid purposes. For all others, the Division of Family Resources (DFR) is responsible for determining initial and continuing eligibility for Indiana Medicaid disability. To meet the disability requirement, a person must have a significant impairment that is expected to last a minimum of 12 months
The Medical Review Team (MRT) determines whether an applicant for Indiana Health Coverage Programs (IHCP) meets the Medicaid definition of disability and notifies the DFR of its decision. Disability determinations are based on medical information requested by the MRT. Providers rendering the services necessary to provide this medical information – such as medical exams, medical tests or record copying – are reimbursed for these services in accordance with an established fee schedule.
To be reimbursed for MRT services, providers must be enrolled with the IHCP and specifically identified as participating in the Medical Review Program. When enrolling with the IHCP, either through the IHCP Provider Healthcare Portal or by completing an IHCP provider enrollment application, providers that wish to provide MRT services may indicate the appropriate Medical Review Program option under Other IHCP Program Participation. Providers that are already enrolled in the IHCP can update their provider profile to add Medical Review Program participation. Nonlicensed providers are eligible to enroll as MRT Copy Center (provider type 34) for reimbursement of medical records copying only.
For more information on the MRT, see the Member Eligibility and Benefit Coverage provider reference module. For more information on enrolling as an MRT provider, see the Provider Enrollment module.