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.
Topical searches across all modules may be completed by entering a word or phrase in the box below and clicking the search button. You will be taken to a new page that lists all modules containing the requested term(s). You can also choose to include IHCP Bulletins and/or Banner Pages (from 2020 to present) in your search results.
IHCP Provider Reference Modules
| | Effective Date* | Version |
|---|
| General Information Modules |
|---|
| Introduction to the IHCP |
July 1, 2023
|
7.0
|
| Prior Authorization |
July 1, 2023
|
7.0
|
| Provider and Member Utilization Review |
Sept. 1, 2023
|
7.0
|
| Provider Enrollment |
Sept. 1, 2023
|
6.0
|
| Provider Healthcare Portal |
July 1, 2023
|
7.0
|
| Eligibility and Benefits Modules |
|---|
| Member Eligibility and Benefit Coverage |
March 1, 2023
|
7.0
|
| Presumptive Eligibility |
Feb. 1, 2023
|
7.0
|
| Right Choices Program |
July 1, 2023
|
6.0
|
| Claims and Billing Procedures Modules |
|---|
| Claim Submission and Processing |
July 1, 2024 | 8.0
|
| Claim Adjustments |
Jan. 1, 2024
|
7.0
|
| Claim Administrative Review and Appeals |
Dec. 1, 2021
|
6.0
|
| Electronic Data Interchange |
March 1, 2023
|
7.0
|
| Financial Transactions and Remittance Advice |
Dec. 1, 2021
|
6.0
|
| National Correct Coding Initiative |
June 1, 2022
|
6.0
|
| Third-Party Liability |
Jan. 1, 2022
|
6.1
|
| Service- and Provider-Specific Modules |
|---|
| Anesthesia Services |
March 1, 2024
|
7.0
|
| Behavioral Health Services |
July 1, 2021
|
3.0
|
| Chiropractic Services |
Feb. 1, 2023
|
7.0
|
| Clinical Trials |
March 1, 2023
|
5.0
|
| Dental Services |
Sept. 15, 2023
|
7.2 |
| Diabetes Self-Management Training Services |
June 1, 2022
|
6.0
|
| Durable and Home Medical Equipment and Supplies |
Nov. 20, 2023
|
6.0
|
| Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Services |
Dec. 1, 2022
|
6.0
|
| Emergency Services |
Jan. 1, 2024
|
7.0
|
| Evaluation and Management Services |
Feb. 1, 2023
|
7.0
|
| Family Planning Services |
Oct. 1, 2023
|
7.0
|
| Federally Qualified Health Centers and Rural Health Clinics |
Oct. 1, 2023
|
7.0
|
| Genetic Testing |
Jan. 1, 2023
|
6.0
|
| Hearing Services |
June 1, 2023
|
7.0
|
| Home- and Community-Based Services Billing Guidelines |
July 1, 2024 | 7.0
|
| Home Health Services |
Sept. 1, 2023
|
7.0
|
| Hospice Services |
July 1, 2024 | 7.0
|
| Hospital Assessment Fee |
Jan. 1, 2023
|
7.0
|
| Injections, Vaccines and Other Physician-Administered Drugs |
Jan. 1, 2023
|
7.0
|
| Inpatient Hospital Services |
July 1, 2022
|
6.0
|
| Laboratory Services |
Feb. 1, 2023
|
7.0
|
| Long-Term Care |
July 1, 2024 | 7.0
|
| Medical Practitioner Reimbursement |
July, 1, 2022
|
4.0
|
| Obstetrical and Gynecological Services |
Jan. 1, 2024
|
7.0
|
| Oncology Services |
Jul. 1, 2022
|
4.0
|
| Out-of-State Providers |
Nov. 1, 2023
|
7.0
|
| Outpatient Facility Services |
Jan. 1, 2024
|
7.0
|
| Pharmacy Services |
Jan. 1, 2023
|
7.0
|
| Podiatry Services |
Nov. 1, 2023
|
7.0
|
| Radiology Services |
March 1, 2024
|
7.0
|
| Renal Dialysis Services |
Oct. 1, 2023
|
7.0
|
| School Corporation Services |
July 1, 2023
|
7.0
|
| Surgical Services |
April 1, 2022
|
6.0
|
| Telehealth and Virtual Services |
Nov. 1, 2023
|
6.1 |
| Therapy Services |
April 1, 2022
|
6.0
|
| Transportation Services |
Oct. 1, 2022
|
5.1
|
| Vision Services |
Sept. 1, 2023
|
7.0
|
| Program-Specific Modules |
|---|
| 590 Program |
Sept. 1, 2023
|
7.0
|
| Family Planning Eligibility Program |
Oct. 1, 2023
|
7.0
|
| Healthy Indiana Plan |
Nov. 1, 2022
|
4.0
|
| Medicaid Rehabilitation Option Services |
Sept. 1, 2023
|
6.0
|
| Program-Specific Modules – Home- and Community-Based Services |
|---|
Division of Mental Health and Addiction
Adult Mental Health Habilitation Services |
July 1, 2024 | 8.0
|
Division of Mental Health and Addiction
Behavioral and Primary Healthcare Coordination Service |
July 1, 2024 | 10.0
|
Division of Mental Health and Addiction
Child Mental Health Wraparound Services |
Dec. 7, 2023
|
7.0
|
Division of Disability and Rehabilitative Services
Home- and Community-Based Services Waivers
(Community Integration and Habilitation, Family Supports, Health and Wellness, Traumatic Brain Injury)
|
July 1, 2024
|
11.1 |
Office of Medicaid Policy and Planning
Home- and Community-Based Services Waiver: Indiana PathWays for Aging |
July 1, 2024
|
1.1 |
* Note: The effective date indicates the date of the policies and procedures included in this version of the module
