Find links to provider code sets, fee schedules, and more.The mission of the Program Integrity Unit is to guard against fraud, abuse, and waste of Medicaid program benefits and resources.Health Insurance Portability and Accountability Act (HIPAA)The Health Insurance Portability and Accountability Act (HIPAA) contains the provisions for portability, Medicaid integrity, and adminitrative simplification.Indiana Medicaid Promoting Interoperability ProgramThe IHCP participates in the federal Promoting Interoperability Program to provide incentives for eligible professionals and hospitals to adopt, implement, upgrade, or demonstrate meaningful use of certified electronic health records (EHR) technology.The Medical Review Team determines an applicant's eligibility based on a disability. You may also check for current income limits or see if you qualify online at the DFR Benefits Portal by clicking here and additional information may also be found on the Indiana Medicaid website. Through this secure and easy to use internet portal: Healthcare providers and Billing Agents can enroll as a Trading Partner with RI Medicaid.
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Providers must be enrolled as MRT providers to be reimbursed for MRT services.Prior authorization is required for certain covered services to document the medical necessity for those services before services are rendered.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.The IHCP reimburses for long-term care services for members meeting level-of-care requirements.The IHCP reimburses for hospice services in a hospice facility, in a nursing facility, and in a private home.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.The IHCP is working in collaboration with stakeholders to expand and improve SUD treatment.Nonemergency medical transportation services for most members served through the fee-for-service delivery system are brokered through Southeastrans Inc.A Notification of Pregnancy transaction helps identify risk factors in the earliest stages of pregnancy and thereby improve birth outcomes.Providers can find pharmacy benefit information for the program/health plan with which the member is enrolled. Take Assessment. If eligibility cannot be renewed through the automated process, recipients will be contacted by mail when it is time for enrollment renewal. Click here for more information about OMPP. Need Help? Age: Certain programs are designed for people in specific age groups.
Find important information for providers, software developers, and trading partners that communicate via electronic data interchange format and direct data entry.Whether you're new to Medicaid or have been a provider for years, this section is designed to help answer your billing questions. When registering your email, check the category on the drop-down list to receive notices of Medicaid updates; check other areas of interest on the drop-down list to receive notices for other types of FSSA updates.Health Insurance Portability and Accountability Act (HIPAA)Indiana Medicaid Promoting Interoperability ProgramProgram for All-inclusive Care to the Elderly (PACE) Are you on a Medicaid plan and looking for a doctor? After successfully enrolling in the IHCP, a provider can contract with one or more of the MCEs to serve their enrolling members. Each program is designed to meet the medical needs of that specific group of individuals. If enrollment occurs on time, there will be no break in program services. Current offerings are posted here.The in-person sessions for the Indiana Health Coverage Programs (IHCP) 2020 Roadshow are now being offered in a virtual format only. Office of Medicaid Policy & Planning. It can also be used to review or modify a registration.Register for virtual training just as you would if you were attending the workshop in person; you will need a telephone and a computer.Find presentations from the most recent IHCP workshops and seminars are archived here.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.It is important that you verify member eligibility on the date of service every time you provide services.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.The IHCP will implement an electronic visit verification (EVV) system for federally required provider documentation of designated personal care and home health services.