IHCP Important updates posted to the website - Published 10/3

​The Indiana Health Coverage Programs (IHCP) posted the following important information to the provider website at indianamedicaid.com on October 3, 2017 (unless alternate date is noted). 

Bulletins and Banner Pages 
BR201740
-IHCP to mass adjust nursing facility, hospice, and PRTF claims for patient liability
-IHCP to mass reprocess LTC claims that denied inappropriately
-IHCP to reprocess or mass adjust claims for psychiatric therapy services that adjudicated incorrectly 
-IHCP will not reimburse for FluMist for the 2017-2018 flu season
-Providers now able to view additional profile information in the Portal 

Provider Reference Modules
-Durable and Home Medical Equipment and Supplies
-Edited text throughout the module for clarity
-Changed Hewlett Packard Enterprise references to DXC Technology
-Added IAC reference to the Prior Authorization Requirements for Medical Equipment and Supplies section and edited list of items exempt from PA to match the IAC
-Updated information in the Manually Priced DME, HME, and Supplies section about items that have no MSRP
-Corrected the IAC reference and added a reference to the LTC Per Diem Table in the Coverage and Billing for DME, HME, and Medical Supplies section
-Updated the Drug-Related Medical Supplies and Medical Devices section to reflect current procedures
-Streamlined the Orthotic and Prosthetic Codes in the Outpatient Setting section and referred to the Outpatient Hospital and Ambulatory Surgical Center Services module for details

Removed specific medical criteria from the following sections and referred to the Medical Policy Manual, for this information instead:
-Automatic External Defibrillators and Wearable Cardioverter Defibrillators
-Cranial Remolding Orthosis
-Osteogenic Bone Growth Stimulators
-Oxygen and Home Oxygen Equipment
-Respiratory Assistive Devices – Bi-Level Positive Airway Pressure (BiPAP) and Continuous Positive Airway Pressure (CPAP)

Added the following sections:
-Custom Tracheostomy Tubes
-Hospital and Specialty Beds
-Negative Pressure Wound Therapy
-Standers

Updated the Diabetic Testing Supplies section, including:
-Added Trividia Health as a preferred vendor
-Updated Table 1 – Preferred Diabetic Supply List
-Removed outdated information for Hoosier Healthwise billing
-Updated eligibility and reimbursement information for long-term continuous glucose monitoring

-Removed outdating billing information and end-dated code from the Enteral and Parenteral Nutrition Pumps for Home Infusion section
-Standardized terminology and removed former product names in the High-Frequency Chest Oscillation System Devices section
-Added billing information to the Incontinence, Ostomy, and Urological Supplies section
-Removed reference to the device being a capped rental item in the Oximetry section
-Clarified information about humidifiers for BiPAPs or CPAPs for dually eligible members in the Humidifiers, Nonheated or Heated section

Updated the Wheelchairs section, including:
-Added clearance form names
-Removed reference to the wheelchair base code
-Clarified that the codes in the Wheelchair Power Seating subsection are considered capped rental items 

Third Party Liability
-Edited and reorganized text throughout the module for clarity
-Changed Hewlett Packard Enterprise references to DXC Technology
-Clarified Portal instructions for accident-related claims in the Liability Insurance section
-In the Waiver Liability Considerations Related to Medicare section, added information about including the HCBS benefit modifier
-Added a note box to the Third Party Liability Reimbursement Requirements section referring to MCEs for managed care TPL procedures and indicated FFS-specific information as needed within the subsections
-Updated the Identifying Third Party Liability section, including adding information about waiver liability
-Replaced references to MRN with EOMB
-Removed the reference to value code A7 from the Medicare Replacement Plan Claims section 

Presumptive Eligibility for Pregnant Women
-Reorganized and edited text throughout, including incorporating the appendixes into the body of the module
-Replaced references to Hewlett Packard Enterprise with DXC Technology
-Added a note box to the Introduction section to distinguish PE from PEPW
-Updated the PEPW Team section and its subsections, including adding the Qualified Providers subsection
-Updated the Requirements for PEPW Qualified Providers section and its subsections, including adding a note that hospitals are no longer eligible to enroll as PEPW QPs 
-Updated the Requirements for PEPW Applicants section, including updating the PEPW income requirements for 2017
-Clarified in the Notification of Pregnancy Process section that the NOP can be submitted only after the member has enrolled with an MCE and her PEPW coverage is reflected in the Portal
-Updated the Benefit Coverage and Reimbursement section

Code Table and Other Updates
The following updated code documents are now available on the Code Sets page:
-Durable and Home Medical Equipment and Services Codes
-All codes were reviewed
-Drug-Related Medical Supplies and Medical Devices Reimbursed as Fee-for-Service for Hoosier Healthwise Prior to January 1, 2017 was updated per BT201717

Prenatal and Preventive Pediatric Care Codes 
-All codes were reviewed
-Prenatal Care ICD-10 Diagnosis Codes That Bypass Cost Avoidance was updated per BT201765

Presumptive Eligibility for Pregnant Women Codes
-All codes were reviewed
-Prenatal Care ICD-10 Diagnosis Codes That Bypass Cost Avoidance was updated per BT201653 and BT201765 

Check out these resources to stay up-to-date with the most recent changes at the IHCP.