Starting next year, Indiana physicians will have less time in which to file Medicaid fee-for-service claims after providing services to patients served by the Indiana Health Coverage Programs (IHCP) of the Indiana Family and Social Services Administration (FSSA). These include the Healthy Indiana Plan, Hoosier Care Connect and Hoosier Healthwise.
Beginning Jan. 1, 2019:
- Physicians must file Medicaid fee-for-service claims within 180 calendar days of the date of service. The current timely filing limit is 365 calendar days.
- For inpatient claims, the 180-day limit will be based on the IHCP member’s date of discharge.
- The current timely filing limit, 365 days, will continue to apply for all claims with dates of service or dates of discharge on or before Dec. 31, 2018.
The new timely filing limit gives physicians more time to file claims than the 90-day limit FSSA previously announced.
Circumstances excluded from the timely filing limit will remain unchanged, as will reasons for extending the timely filing limit and circumstances under which the limit might be waived with proper documentation. In brief, these are:
- Crossover claims.
- Overpayment adjustment requests.
- A member’s eligibility is effective retroactively.
- Prior authorization for a service is approved retroactively.
- An IHCP policy change is effective retroactively.
- For waiver providers, a plan of care is delayed.
- Third-party payer notification is delayed.
- Lack of timely filing is due to an error or action by DXC Technology, OptumRx, or the state of Indiana.
- Reasonable and continuous unsuccessful attempts by the provider to receive payment from a third party, such as Medicare or another insurance carrier.
- Reasonable and continuous unsuccessful attempts by the provider to resolve a claim problem.
Physicians are urged to read the IHCP Bulletin BT201829 in its entirely to learn details of the changes, including additional information about exclusions, extensions and waivers of the 180-day filing limit. The bulletin is available on ISMA’s website