Indiana Health Coverage Programs (IHCP) programs recently published multiple bulletins that will impact Hoosier physicians and their patients.
Guidance provided regarding continuity of care for members transitioning between IHCP programs
The Indiana Family and Social Services Administration’s (FSSA) Office of Medicaid Policy and Planning (OMPP) has posted information on providing continuity of care for patients that are transitioning between various IHCP programs.
Bulletin 202496 provides the update, including information on service authorizations for members transitioning to PathWays for Aging.
FSSA reminds PathWays HCBS providers to register on each managed care entity provider portal
The FSSA is encouraging all PathWays Home- and Community-Based Services (HCBS) service providers to register for all three managed care entity (MCE) provider portals to stay informed and ensure smooth transition to the PathWays program, which went live on July 1.
Bulletin 292498 provides information on registering for the MCEs.
Coverage information for the July 2024 quarterly HCPCS update
IHCP has reviewed the July 2024 quarterly Healthcare Common Procedure Coding System (HCPCS) update to determine coverage. Coverage information in Table 1 is effective for dates of service (DOS) on or after July 1, 2024, unless otherwise specified.
IHCP is also awaiting the final posting of the Centers for Medicare & Medicaid Services (CMS) fee schedules and documentation affecting coverage and pricing for the procedure codes. After the final review is completed, IHCP will issue a publication detailing the additional coverage and pricing information.
The covered HCPCS codes from the July 2024 quarterly update will be added to the claim-processing system. For more information about the July 2024 quarterly HCPCS update, see the
HCPCS Quarterly Update page of the CMS website at cms.gov.
Read more in
BT202497.
IHCP identifies FFS claim-processing issue that occurred June 19
IHCP has identified an issue in the fee-for-service (FFS) claim-processing system that impacted claims being processed on June 19, 2024, from midnight through 2:30 p.m.
Claims may have denied in error for the following explanations of benefits (EOBs):
◼ 4107 – Revenue code or type of claim is not appropriate/not covered for the type of service or type of provider.
◼ 0532 – Billing provider's specialty is not approved to bill this revenue code. Please verify and resubmit.
◼ 4218 – Service billed is not allowed on this claim type.
◼ 4975 – The service billed is not applicable for the member's benefit plan.
◼ 9999 – Processed per policy.
◼ 2033 – Invalid claim type for the program billed.
The system has been corrected, and claims will be reprocessed immediately. Adjusted claims will be identified with internal control numbers (ICNs)/Claim IDs that begin with 80 (reprocessed denied claims).