The Indiana Health Coverage Programs (IHCP) posted the following important information to the provider website at https://www.in.gov/medicaid/providers/ on December 18, 2018, (unless alternate date is noted).
• IHCP to mass adjust claims to which patient liability deductions were applied incorrectly
• IHCP clarifies guidance regarding NEMT services for members eligible for both Medicaid and Medicare
The Indiana Health Coverage Programs (IHCP) has identified a claim-processing issue that affects certain fee-for-service (FFS) claims for long-term care services processed from February 13, 2017, through July 18, 2018. In error, patient liability was deducted from claims for certain members after the members’ patient liabilities were fulfilled.
The claim-processing system has been corrected. Claims for affected members processed during the indicated time frame will be mass adjusted. Providers should see the adjusted claims on Remittance Advices (RAs) beginning January 23, 2019, with internal control numbers (ICNs)/Claim IDs that begin with 52 (mass replacement noncheck related). For claims that were underpaid, the net difference will be paid and reflected on the RA.
If providers collected excess patient liability amounts from members based on the initial adjudication of the affected claims, providers are required to refund the money to the members.
Provider Reference Modules
Medicaid Rehabilitation Option Services
• Updated the example in the Examples section for Skills Training and Development to be specific to the individual setting
• Updated the Level of Need section to include new Portal information
• Added Error 1600 to step 2 in the Service Package Assignment Process section
• In the Verifying Eligibility for MRO Services on the Provider Healthcare Portal section, clarified the process for entering the date (step 3) and updated the remaining steps and figures to reflect changes in the Portal
• Updated the PA Submission section to clarify information regarding submitting a system update and to add information about viewing authorization numbers in the Portal
• Removed sentence from the MRO Reimbursement section about only physicians and HSPPs receiving IHCP Provider IDs
• Removed general information not specific to MRO services from the Managed Care Considerations section and its subsections
Interactive Voice Response System
• Updated the Introduction section to indicate that benefit limit info on the IVR is for FFS only and to clarify the use of the IVR for revalidation payments
• Updated the introduction to the Service Restrictions section to reflect changes in the information returned
• Updated Table 9 – IVR System – Service Restrictions as follows:
• Clarified in Step 5-8a that the RCP physician response is used for the PMP and also for referred providers
• Removed HIP copayment response from Step 5.8c
• Added a response for Southeastrans NEMT to Step 5.8c
• Added a new Step 5.8d for the new FFS copayment response
• Clarified LOC language in Step 5-8e
• Updated the introduction to the Benefit Limits section as follows:
• Removed statements about benefit limit information being provider-specialty-specific
• Added a caveat that the information assumes standard, Traditional Medicaid coverage
Code Table and Other Updates
The following updated code tables are now available on the Code Sets page:
Medicaid Rehabilitation Option Services Codes
• All codes were reviewed
Check out these resources to stay up-to-date with the most recent changes at the IHCP.