On May 4, 2016, HMS, a vendor of the Indiana Health Coverage Programs (IHCP), sent a number of paid Medicaid claims for home and community-based services (HCBS) to third-party insurers for waiver members who carry private insurance. This action was taken in accordance with Code of Federal Regulations 42 CFR §433 Subpart D, which requires Medicaid to bill potentially liable third-party insurers to ensure that Medicaid is the payer of last resort. Because this process had not previously been followed for HCBS waiver claims, the claims recently sent, called reclamation claims, related to dates of service (DOS) back to 2013.
Because these claims were already paid by Medicaid, there should be no action required of waiver providers or members. However, if questions arise pertaining to the member's third-party insurance or reclamation claims, contact Kathy Myers at HMS by telephone at (317) 696-6266 or by email at Kathy.Myers@hms.com. You may also call HMS toll-free at 1-888-831-2715. Please have the EOB from the third-party insurance carrier available when making inquiries to HMS.
We hope this information is helpful. If you have questions, please contact the INARF office.