Indiana Health Coverage Programs (IHCP) is updating the physician reimbursement adjustment policies to coincide with the January 2024 Healthy Indiana Plan (HIP) Rate Equalization Project. 

Table 1 reflects the changes made to practitioner, procedure-based and site-of-service adjustments. When implemented, these changes will be effective retroactive to dates of service (DOS) on or after Jan. 1, 2024. For physician rate adjustments, the IHCP is moving from Indiana Medicaid to Medicare policies, where applicable. For areas with no Medicare policy, IHCP policy will continue to be used. Any claims submitted for DOS on or after Jan. 1 that did not receive the current adjustment must be reprocessed. 

Providers can expect to see adjustments to affected fee-for-service (FFS) claims after the system changes have been completed in the Core Medicaid Management Information System (CoreMMIS). An additional publication will be issued regarding FFS claim adjustments.

The managed care entities (MCEs) must also make system changes. The following information applies to the MCEs for system change completion:

• Anthem completed changes Feb. 9, 2024
• CareSource expected to complete changes by March 7, 2024
• MDwise completed changes Jan. 23, 2024
• Managed Health Services (MHS) completed changes Jan. 29, 2024
• UnitedHealthcare (UHC) completed changes Jan. 15, 2024

Any managed care claims submitted that did not receive the current adjustment must be reprocessed by the MCEs. 

Read more in BT202426.

Revised coverage and billing information for the 2024 annual HCPCS codes update

IHCP has reviewed the 2024 annual Healthcare Common Procedure Coding System (HCPCS) update to determine coverage and billing guidelines.

The coverage and billing information in BT202425 replaces the information published in BT2023182. The IHCP coverage and billing information provided in BT202425 is effective for DOS on or after Jan. 1, 2024, unless otherwise specified. Providers have 90 days from the date of this publication for managed care claim submission or 180 days from the date of publication for fee-for-service (FFS) claim submission to satisfy timely filing requirements. Providers should include a copy of the bulletin when submitting claims beyond the standard filing limit.