The Indiana Health Coverage Programs (IHCP) recognizes that timely identification of risk factors improves birth outcomes. For expectant managed care members, the IHCP encourages providers to submit a Notification of Pregnancy (NOP) transaction to help identify risk factors in the earliest stages of pregnancy.
NOPs can be completed at any time during the managed care member's pregnancy, preferably during the initial visit, to document and monitor pregnancy conditions. If a managed care member's normal pregnancy becomes high-risk, providers should use the NOP to document the change.
The submitted information is used by the member's managed care entity (MCE) to determine the risk level associated with the pregnancy and establish areas of follow-up care.
NOP Reimbursement
Recognized providers are eligible for a $60 reimbursement for NOP transactions that meet the following requirements:
- The member must be enrolled with an MCE, either through the Healthy Indiana Plan (HIP), Hoosier Care Connect or Hoosier Healthwise programs, or as a presumptively eligible individual that has enrolled with an MCE.
- The member's pregnancy must be less than 30 weeks gestation at the time of the office visit on which the NOP is based.
- The NOP must be submitted no more than five calendar days from the date of the office visit.
- The NOP must be submitted via the IHCP Provider Healthcare Portal by a billing or group provider with an applicable specialty. (See the Obstetrical and Gynecological Services provider reference module for details.)
- Reimbursement is limited to one NOP per pregnancy.
Associated Links
More information about the NOP, including billing guidance, is available at the following links:
- NOP Training Presentation
- Sample NOP Form (Note: The actual NOP Form must be accessed through the IHCP Provider Healthcare Portal and submitted electronically.)
- Obstetrical and Gynecological Services provider reference module