- How can someone apply for Medicaid?
Persons interested in applying for Medicaid should review the information provided on the Indiana Medicaid for Members website or the Division of Family Resources website.
- How can I become a Medicaid provider?
ealthcare practitioners, facilities and other providers interested in enrolling with the Indiana Health Coverage Programs (IHCP) can submit applications online through the IHCP Provider Healthcare Portal (IHCP Portal) or by mail, using the appropriate provider enrollment packet. For more information, see the IHCP Provider Enrollment Transactions page on this website.
- How can I update my provider information (address, taxpayer identification number, specialty, electronic funds transfer and so on) on file with the IHCP?
Updates to the provider information on file can be made online (through a registered IHCP Portal account) or by mail. Please follow the instructions on the Update Your Provider Profile page of this website.
- What codes should I use to bill my claim? For service-, provider- or benefit-specific coding information, refer to the relevant IHCP provider reference modules and code table documents. See the Claim Submission and Processing provider reference module to view general requirements for billing a claim to the IHCP. Changes to policies and procedures that occur after the effective date noted for each module are announced in IHCP Banner Pages and Bulletins. If you have additional questions, please contact your Provider Relations consultant.
Note: For members enrolled in a managed care program (such as Healthy Indiana Plan, Hoosier Care Connect or Hoosier Healthwise), contact the member’s managed care entity (MCE) for billing and coding guidelines. See the IHCP Quick Reference Guide for contact information. - How can I determine whether an individual is enrolled in Medicaid for a particular date of service? IHCP providers can verify a member’s eligibility (IHCP enrollment status, benefit plan assignment and so on) using one of three methods, as described in the Member Eligibility and Benefit Coverage provider reference module:
- IHCP Provider Healthcare Portal
- Approved vendor software for the 270/271 batch or interactive eligibility benefit transactions
- Interactive virtual assistant at 800-457-4584 (option 2)
- How can I determine whether a service is covered?
- Providers that bill services on the professional claim (CMS-1500 claim form or electronic equivalent) or the dental claim (ADA 2012 claim form or electronic equivalent) can use the Professional Fee Schedule to determine IHCP-covered services.
- Providers that bill outpatient services on the institutional claim (UB-04 or electronic equivalent) can use the Outpatient Fee Schedule to determine IHCP-covered services.
- For information about inpatient service coverage, see the Inpatient Hospital Services provider reference module.
- Information for pharmacy billers is in the Pharmacy Services provider reference module.
Note: Individual coverage for a particular service varies by benefit plan assignment, among other factors. Not all IHCP members are eligible for full Medicaid benefits; see the Member Eligibility and Benefit Coverage provider reference module for details. - Did you receive my transmission of electronic claims (submitted via 837 electronic data interchange transmission)?
The 999 Functional Acknowledgement provides trading partners with verification that claims submitted electronically have been accepted for processing. The 999 also identifies any claims rejected because of Health Insurance Portability and Accountability Act (HIPAA) compliance violations. The 999 is available for download immediately after the claim file is submitted. Contact your claim-submission software vendor for more details.
- What is the status of my submitted claim or claim-adjustment request? Processed claims and claim adjustments appear on the provider’s monthly Remittance Advice (RA) or 835 electronic transaction. Additionally, providers (and their delegated representatives) can use the IHCP Provider Healthcare Portal to check the status of a claim or claim adjustment at any time. For claims and claim adjustments submitted by mail, please allow at least 45 days after submission before calling Customer Assistance to inquire about the status of the claim or adjustment. See the Claim Submission and Processing and Claim Adjustments provider reference modules for more information.
Note: This answer pertains to fee-for-service claims. For claims submitted to a managed care entity (MCE), follow the MCE’s procedures for checking the status of the claim or claim adjustment. - What testing is needed for approval of trading partner software for exchanging electronic data with the IHCP?
Instructions on how to become a Health Insurance Portability and Accountability Act (HIPAA) trading partner are available from the Electronic Data Interchange (EDI) Solutions page of this website.
- What is HIPAA? How does it affect me?
HIPAA refers to the Health Insurance Portability and Accountability Act. Please read the HIPAA information available on this website.
Language Translation
Provider Enrollment
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Become a Provider
Become a Provider
Enroll as a provider with the IHCP to bring critical medical care to eligible Hoosier children and adults.
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IHCP Provider Enrollment Transactions
IHCP Provider Enrollment Transactions
The IHCP provider enrollment instructions and processes are outlined on these web pages.
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Complete an IHCP Provider Enrollment Application
Complete an IHCP Provider Enrollment Application
Enrollment transaction submissions are needed to enroll, add a service location, report a change of ownership, revalidate, or update provider profile information.
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Maintaining Your IHCP Provider Enrollment
Maintaining Your IHCP Provider Enrollment
The information that identifies and describes an enrolled IHCP provider is called a Provider Profile. Providers are responsible for keeping all the information in the Provider Profile up-to-date.
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Family Member/Associate Transportation Providers
Family Member/Associate Transportation Providers
The IHCP allows a family member or close associate of a Medicaid member to officially enroll as a driver, so the driver's mileage can be reimbursed.
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Ordering, Prescribing or Referring Providers
Ordering, Prescribing or Referring Providers
IHCP reimbursement for services or medical supplies resulting from a practitioner's order, prescription or referral requires the ordering, prescribing or referring (OPR) provider to be enrolled with the IHCP.
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Enrolling as a Managed Care Program Provider
Enrolling as a Managed Care Program Provider
IHCP-enrolled providers interested in enrolling as a provider for Healthy Indiana Plan (HIP), Hoosier Healthwise, or Hoosier Care Connect members must apply directly to one or more of the managed care entities (MCEs).
Provider References
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Bulletins, Banner Pages and Reference Modules
Bulletins, Banner Pages and Reference Modules
View and search bulletins, banner pages and provider reference modules for information and updates on important topics including IHCP policies and procedures.
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Current News
Current News
View IHCP announcements about upcoming events and other timely news items, and access communications published by IHCP's partnering managed care entities.
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Code Sets
Code Sets
View code tables associated with particular IHCP policies – such as procedure codes allowable for certain provider specialties, diagnosis and service codes covered under a particular benefit plan, and so on.
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Email Notifications
Email Notifications
The email notifications are used to send notices to subscribers on behalf of the IHCP. To receive notices, you must subscribe.
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Forms
Forms
Find the forms you need to serve members and transact business with the IHCP.
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IHCP Provider Locator
IHCP Provider Locator
The provider search tool enables you to locate providers enrolled with the IHCP to provide services to Medicaid members.
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OPR Provider Verification
OPR Provider Verification
IHCP providers should verify enrollment of the ordering, prescribing or referring (OPR) provider before services or supplies are rendered.
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Other Provider Resources
Other Provider Resources
Visit this page to access additional resources, including code tables, companion guides for electronic transactions, the Indiana State Plan, and answers to frequently asked questions about the IHCP.
Provider Education
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Provider Education Opportunities
Provider Education Opportunities
The IHCP offers provider training opportunities including instructor-led workshops, seminars, webinars, and self-directed web-based training modules. Current offerings are posted here.
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2024 IHCP Works
2024 IHCP Works
The Indiana Health Coverage Programs (IHCP) invites providers to attend the 2024 IHCP Works seminar from Oct. 8 through Oct. 10.
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IHCP Live
IHCP Live
IHCP Live webinars offer providers an opportunity to learn about new policy initiatives and billing guidance. Visit this page for information about upcoming webinars and recordings of past presentations.
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IHCP Quick Hits
IHCP Quick Hits
View short, informational videos on topics of special interest to IHCP providers.
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Program Integrity Provider Education Training
Program Integrity Provider Education Training
These provider education training links cover topics such as documentation requirements, billing guidelines, and other program integrity- and audit-related issues.
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IHCP Provider Healthcare Portal Training
IHCP Provider Healthcare Portal Training
Providers and their delegates can learn how to make the most of the IHCP Provider Healthcare Portal through web-based training sessions.
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PE Qualified Provider Training
PE Qualified Provider Training
Providers interested in becoming qualified providers (QPs) for presumptive eligibility (PE) must complete an application through the IHCP Portal and contact IHCP Provider Relations to arrange training.
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Electronic Visit Verification Training
Electronic Visit Verification Training
Check this page for training opportunities around electronic visit verification (EVV) for personal care and home health services.
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Archived Workshop Presentations
Archived Workshop Presentations
Find presentations from the most recent IHCP workshops and seminars are archived here.
Business Transactions
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Portal Links for Providers
Portal Links for Providers
This page offers quick access to the most commonly used provider portals for IHCP transactions, such as prior authorization, claim submissions and enrollment updates.
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IHCP Provider Healthcare Portal
IHCP Provider Healthcare Portal
The IHCP Provider Healthcare Portal is an internet-based solution that offers enhanced reliability, speed, ease of use, and security to providers and other partners doing business with the IHCP.
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Eligibility Verification
Eligibility Verification
It is important that you verify member eligibility on the date of service every time you provide services.
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Presumptive Eligibility (PE)
Presumptive Eligibility (PE)
The Presumptive Eligibility process allows qualified providers to make PE determinations for certain eligibility groups to receive temporary health coverage until official eligibility is determined.
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Electronic Visit Verification
Electronic Visit Verification
The IHCP will implement an electronic visit verification (EVV) system for federally required provider documentation of designated personal care and home health services.
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Electronic Data Interchange (EDI) Solutions
Electronic Data Interchange (EDI) Solutions
Find important information for providers, software developers, and trading partners that communicate via electronic data interchange format and direct data entry.
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Billing and Remittance
Billing and Remittance
Whether you're new to Medicaid or have been a provider for years, this section is designed to help answer your billing questions. Find links to provider code sets, fee schedules and more.
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Program Integrity
Program Integrity
The mission of the Program Integrity Unit is to guard against fraud, abuse, and waste of Medicaid program benefits and resources.
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Health Insurance Portability and Accountability Act (HIPAA)
Health Insurance Portability and Accountability Act (HIPAA)
The Health Insurance Portability and Accountability Act (HIPAA) contains the provisions for portability, Medicaid integrity, and administrative simplification.
Clinical Services
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Medical Review Team (MRT)
Medical Review Team (MRT)
The Medical Review Team determines an applicant's eligibility based on a disability. Providers must be enrolled as MRT providers to be reimbursed for MRT services.
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Prior Authorization
Prior Authorization
Prior authorization is required for certain covered services to document the medical necessity for those services before services are rendered.
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Preadmission Screening and Resident Review (PASRR)
Preadmission Screening and Resident Review (PASRR)
The Preadmission Screening and Resident Review process is a requirement in all IHCP-certified nursing facilities, prior to admission or when there is a significant change in the physical or mental condition of a resident.
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Long-Term Care
Long-Term Care
The IHCP reimburses for long-term care services for members meeting level-of-care requirements.
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Hospice
Hospice
The IHCP reimburses for hospice services in a hospice facility, in a nursing facility, and in a private home.
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Medicaid Rehabilitation Option (MRO)
Medicaid Rehabilitation Option (MRO)
IHCP Medicaid Rehabilitation Option services include community-based mental health care for individuals with serious mental illness, youth with serious emotional disturbance, and/or individuals with substance use disorders.
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Substance Use Disorder (SUD)/Serious Mental Illness (SMI) Treatment
Substance Use Disorder (SUD)/Serious Mental Illness (SMI) Treatment
Learn more about the IHCP implementation of Section 1115 SUD and SMI demonstration waivers to expand treatment of substance use disorder (SUD) and serious mental illness (SMI).
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Nonemergency Medical Transportation
Nonemergency Medical Transportation
Nonemergency medical transportation services for most members served through the fee-for-service delivery system are brokered through Southeastrans Inc.
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Notification of Pregnancy (NOP)
Notification of Pregnancy (NOP)
A Notification of Pregnancy transaction helps identify risk factors in the earliest stages of pregnancy and thereby improve birth outcomes.
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Pharmacy Benefits
Pharmacy Benefits
Providers can find pharmacy benefit information for the program/health plan with which the member is enrolled.
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Preferred Diabetes Supply List (PDSL)
Preferred Diabetes Supply List (PDSL)
The Preferred Diabetes Supply List helps ensure that IHCP members receive the highest quality products at the lowest cost.
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Right Choices Program (RCP)
Right Choices Program (RCP)
The Right Choices Program monitors member utilization and, when appropriate, implements restrictions for members who would benefit from increased case coordination.
About IHCP Programs
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IHCP Programs and Services
IHCP Programs and Services
Indiana Medicaid provides a healthcare safety net to Hoosier children, aged, disabled, pregnant women, and other eligible populations under the umbrella of Indiana Health Coverage Programs (IHCP).
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Traditional Medicaid
Traditional Medicaid
Traditional Medicaid is a program created to provide health care coverage to individuals who are not enrolled in managed care. Members normally served in Traditional Medicaid include individuals eligible for both Medicare and Medicaid, individuals who...
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Healthy Indiana Plan
Healthy Indiana Plan
The Healthy Indiana Plan is a health-insurance program for qualified adults ages 19-64.
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Hoosier Care Connect
Hoosier Care Connect
Hoosier Care Connect is a health care program for individuals who are aged 65 years and older, blind, or disabled and who are also not eligible for Medicare. Children who are wards of the State, receiving adoption assistance, foster children and former...
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Hoosier Healthwise
Hoosier Healthwise
Hoosier Healthwise is a health care program for children up to age 19 and pregnant women. The program covers medical care like doctor visits, prescription medicine, mental health care, dental care, hospitalizations, and surgeries at little or no cost...
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Indiana PathWays for Aging
Indiana PathWays for Aging
Indiana PathWays for Aging is a new managed care health program for eligible Hoosiers age 60 and older. This program begins July 1, 2024.
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Program of All-Inclusive Care for the Elderly (PACE)
Program of All-Inclusive Care for the Elderly (PACE)
PACE provides community-based care for qualified members who are 55 and older that live in a PACE service area.
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Medicaid Rehabilitation Option (MRO)
Medicaid Rehabilitation Option (MRO)
IHCP Medicaid Rehabilitation Option services include community-based mental health care for individuals with serious mental illness, youth with serious emotional disturbance, and/or individuals with substance use disorders.
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Home- and Community-Based Services (HCBS)
Home- and Community-Based Services (HCBS)
HCBS programs are intended to assist a person to be as independent as possible and live in the least restrictive environment possible while maintaining safety in the home.
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Family Planning Eligibility Program
Family Planning Eligibility Program
Low-income individuals who don't qualify under another eligibility category may qualify for family planning services under the Family Planning Eligibility Program.
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590 Program
590 Program
The 590 Program provides coverage for certain healthcare services provided to members who are residents of state-owned facilities.
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Medicare Savings Programs
Medicare Savings Programs
Medicare Savings Programs pay Medicare coinsurance, deductibles, and/or premiums for qualified elderly and disabled individuals.
Contact Information
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Contact Us
Contact Us
The IHCP is interested in hearing from you if you have input or need assistance.
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IHCP Quick Reference Guide
IHCP Quick Reference Guide
The IHCP Quick Reference Guide lists phone numbers and other information for vendors.
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Portal Links for Providers
Portal Links for Providers
This page offers quick access to the most commonly used provider portals for IHCP transactions, such as prior authorization, claim submissions and enrollment updates.
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Policy Consideration Requests
Policy Consideration Requests
The Indiana Health Coverage Programs (IHCP) has a specific process for members, providers, or other interested parties who would like to submit requests for policy consideration.
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Provider Relations Consultants
Provider Relations Consultants
Provider Relations regions are organized to minimize provider wait times when providers need assistance.