In its July 27 bulletin, the Indiana Health Coverage Programs (IHCP) announced it is immediately reducing the submission requirements for requesting a claim administrative review by Gainwell Technologies for fee-for-service nonpharmacy claims.

Providers, using their own discretion, are now only required to submit any pertinent documentation supporting reconsideration. 

According to IHCP, it’s important to remember:

• Items that were originally required with the claim — such as medical records, TPL forms, filing limit documentation and other claim attachments — are likely necessary to support the request and should be included.
• Providers are strongly encouraged to submit a properly completed paper claim form with the administrative review request, to expedite claim processing in the event the administrative review decision overturns the original claim decision.

If the original claim decision is overturned and a claim form was not supplied, Gainwell will provide instructions on submitting the claim. Providers will need to submit the claim form within 30 days of notification of the decision, and failure to do so could result in the administrative review closing without reprocessing the claim. 

Read more in IHCP Bulletin 202387.