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The Indiana Health Coverage Programs (IHCP) posted the following important information to the provider website at indianamedicaid.com on May 16, 2017 (unless alternate date is noted). Bulletins and Banner Pages BR201720 - Transportation code A0425 denying for NCCI MUE - POA indicator issues corrected in CoreMMIS and the Portal - IHCP identifies top 20 EOB denial codes - Save the date for the 2017 second-quarter IHCP provider Provider Reference Modules
Inpatient Hospital Services - Reorganized text and made edits as needed for clarity - Changed RID references to IHCP Member ID - Changed IndianaAIM references to CoreMMIS - Changed Web interChange references to Provider Healthcare Portal (Portal), and added Portal instructions for billing as needed - Removed ICD-9 information - Updated EOB description in the PA Policy for Inpatient Stays for Burn Care section - Added information for MCE contacts in the General Inpatient Billing and Coding Procedures section - Updated the Present on Admission Indicators section - Included reference to implantable DME in the Diagnosis-Related Group Reimbursement System section - Updated the Customer Assistance telephone number - Updated the AP-DRGs excluded for psychiatric cases in the Inpatient Level-of-Care Reimbursement System section - Updated the section of the RA in which medical education payment information appears in the Medical Education Reimbursement for Encounter Claims section - Updated the list of IHCP-enrolled children's hospitals in the DRG Base Rate for Children's Hospitals section - Updated the Hospital-Acquired Conditions Policy section - Updated EVS information in the Inpatient Coverage for Department of Correction Inmates section - Changed Medicare Remittance Notice (MRN) references to Explanation of Medicare Benefits (EOMB) - Clarified "same or related" in the Readmissions section - Updated the Inpatient Stays Less Than 24 Hours section and Inpatient-Only Codes subsection Home and Community-Based Services Billing Guidelines - Reorganized and edited text throughout for clarity and consistency - Replaced Web interChange references with Provider Healthcare Portal - Replaced IndianaAIM references with CoreMMIS - Replaced LPI references with Provider ID - Added notation regarding PRTF Transition Waiver - Removed references to MFA-CIH and MFA-PRTF - Added the HCBS Benefit Combinations section - Added web page references to the Authorization of 1915(i) HCBS Benefit Plan Services section - Added the HCBS Eligibility Verification heading and expanded information in that section to reflect CoreMMIS processes - Updated the HCBS Billing Instructions section, including: - Updated Table 1 - Expanded information in the Special Processing for HCBS Provided on Long-Term Care Discharge Dates or During Hospice Level of Care section - Added the Third-Party Liability Exemption section - Updated the HCBS Provider Reimbursement section Medicaid Rehabilitation Option Services - Edited and reorganized text throughout for clarity - Replaced IndianaAIM references with CoreMMIS - Replaced Web interChange references with the Provider Healthcare Portal - Replaced AVR system references with IVR system - Replaced LPI references with Provider ID - Replaced references to Clinic Option with "outpatient mental health services" (405 IAC 5 20 8) - Updated the Crisis Intervention section and removed the HW modifier from H2011 throughout the module - Updated the Intensive Outpatient Treatment section, including adding information about service unit limitations - Updated the Medication Training and Support section, including clarifying age limitations for group-based services - Added the Psychosocial Rehabilitation (Clubhouse Services) section, and added references to this service wherever appropriate - Updated the 1915(i) HCBS State Plan Amendment Programs and MRO Services section - Updated Section 4: Medicaid Rehabilitation Option Service Packages to reflect CoreMMIS processes - Updated Section 5: Prior Authorization, including: - Replaced ADVANTAGE references with Cooperative Managed Care Services (CMCS) and updated P.O. box - Added information about submitting PA via the Portal - Clarified information in the Retroactive PA Policy and PA and Service Package Assignment subsections - Updated Section 6: Clinical Record Documentation Requirements, including: - Updated examples to include provider name - Added the Psychosocial Rehabilitation Documentation section - Updated and clarified information in Section 7: Billing and Reimbursement Requirements for MRO Services, including: - Clarified information about MRO billing for managed care members in the Claim Format section - Added place-of-service code 32 in the Place of Service Codes section - Updated Table 21 - MRO HCPCS Codes - Replaced the table in the Third-Party Liability Requirements section with a general statement - Updated the Customer Assistance telephone number - Updated Appendix A: MRO Service Packages, including adding HCPCS codes to the tables Presumptive Eligibility for Pregnant Women - Reorganized and edited text as needed for clarity - Replaced Web interChange references with Provider Healthcare Portal and updated related instructions and figures - Replaced IndianaAIM references with CoreMMIS - Updated information regarding the PEPW ID for members with an existing Member ID (RID) - Updated the Presumptive Eligibility Claim Billing section to reflect new eligibility verification processes and terminology - Updated Appendix A to reflect the PEPW member application fields Check out these resources to stay up-to-date with the most recent changes at the IHCP. 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