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Seeing HIP 2.0 patients? Details you’ll need
e-Reports, March 9, 2015
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If you are a Medicaid and HIP provider, you’ll likely be busier in the coming months. Numbers show Hoosiers are embracing the recently approved Healthy Indiana Plan (HIP) 2.0. In the first two weeks since the announcement by Gov. Pence, approximately 180,000 immediately enrolled, and 24,150 phone call inquiries were received. Enrollment is expected to grow because 24,000 notices were mailed to marketplace members; also an advertising campaign and enrollment events are getting underway.

IHCP Provider workshops
The Indiana Health Coverage Programs (IHCP) is offering one-day educational workshops to providers throughout the state during March 2015.

March 9

St. Catherine's Hospital
East Chicago

March 10
Terre Haute Regional Hospital
Terre Haute

March 12
Dearborn County Hospital

March 17
IU Bloomington Hospital

March 17
Unity Healthcare

March 18
Scott Memorial Hospital

March 24
St. Vincent Hospital

Keep reading ISMA Reports for more information and training session details.

Informational sessions are scheduled for physicians and other health care providers in the month of March on topics like new hospital presumptive eligibility, fee-for-service updates – and more. See the schedule on the left and check the link for additions in the coming weeks.

For dates of service on or after Feb. 1, 2015, the reimbursement rate for most physician services was adjusted – in aggregate – to 75 percent of the 2014 Medicare Physician Fee Schedule. However, rates for some services may remain unchanged, and others may decrease since they are already reimbursed at equal to or greater than 75 percent of Medicare rates.

Both HIP Plus and HIP Basic cover family planning services, in addition to comprehensive coverage for other health services. Reimbursement for non-delivery maternity and prenatal services is increasing in aggregate to 100 percent of the 2014 Medicare rate. Generally, if a service is covered under Medicaid, it is covered under HIP. Read more about reimbursement changes here.

To participate in HIP 2.0, you must be an Indiana Health Coverage Provider. In other words, you cannot be a provider for HIP patients and not for Medicaid patients. And you must enroll with a managed care entity to provide in-network services to HIP patients. The three risk-based managed care entities are Anthem, MDWise and Managed Health Services (MHS). All HIP members will have a primary medical provider.

Billing for HIP 2.0
Scott Gartenman, Provider Relations manager for the Office of Medicaid Policy and Planning, provided these tips for billing HIP 2.0 members:

  • Currently, providers should submit their claims to the managed care plan assigned to the HIP 2.0 eligible members on Web interChange and verify eligibility on the date services are provided to all members.
  • When verifying eligibility, HIP Plus or HIP State Plan Plus members do not have a co-payment, and the claim may be billed to their managed care plan for the full amount of the covered service. However, a $4 per-service co-payment should be collected from HIP Basic or HIP State Plan Basic members. For example, if a member receives an office visit and the provider performs a drug test, the co-payment collected for those two services would be $8. When billing for those services, the provider will be reimbursed $8 less for the two services to reflect the co-payment responsibility of the member.
  • Starting this summer, providers will be encouraged to register to accept payment via a member’s POWER account. The account will be transitioned to a credit/debit card-based system, and payment can be obtained by running the member's card in the same manner as a credit or debit card. Anthem, MHS and MDwise will be distributing a free cost estimator tool allowing providers access to the appropriate payments for services rendered.
Medicaid Reimbursement Rate Increases

After accessing the payment information, providers will run the member's POWER account card for payment on their credit card machines and be paid immediately from the funds remaining in the member's POWER account. Providers should then submit the claim attached to that billing to the appropriate managed care plan to complete the payment/claims billing cycle.

To learn more, see the webinar on the Indiana FSSA website. Also, check out the Helpful Tools section of the HIP website.

If patients ask you about HIP, refer them to the HIP website for more information, or they can call 1-877-GET-HIP-9.

HIP 2.0 Reimbursement rates

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