- Provider Audit Workgroup to meet August 23
The Provider Audit Workgroup, established by Senate Enrolled Act 364 to "discuss the policies and procedures used in the performance of Medicaid provider audits and possible improvements to the audit process," will meet August 23, 2016, from 2:00 - 4:00 p.m. in the Indiana Government Center South, Conference Rooms 1 and 2. See the full article for more details.
- RID numbers change for newly eligible members
As the Indiana FSSA moves to a new eligibility system, a new numbering sequence is being used for member identification numbers (RIDs). Beginning July 17, 2016, RIDs issued to newly eligible members include a “120” prefix rather than a “100” prefix. New RIDs continue to follow the same 12-digit format of 12xxxxxxxx99. All previously assigned "100" RIDs remain intact. Presumptive Eligibility RIDs are also unaffected.
- Indiana EHR MAPIR upgraded, new user guides available
Indiana Medicaid's Electronic Health Records (EHR) Medical Assistance Provider Incentive Repository (MAPIR) has been upgraded and is now accepting Program Year 2015 Meaningful Use (MU) attestations for eligible professionals (EPs). In addition, new EHR user guides are now available.
- HCBS waiver claims sent to third-party insurers
A number of paid HCBS claims have been sent to third-party insurers for waiver members who carry private insurance. This action was taken in accordance with federal regulations, which require Medicaid to bill potentially liable third-party insurers to ensure that Medicaid is the payer of last resort. Because these claims were already paid by Medicaid, there should be no action required of waiver providers or members.
- Pharmacies overdue for revalidation are at risk of disenrollment
Indiana Health Coverage Programs (IHCP) records indicate that several pharmacies overdue for revalidation have not yet submitted the necessary revalidation paperwork to the IHCP. Failure to revalidate will result in these pharmacies being disenrolled from the IHCP as of July 31, 2016. See the full article for more information.
- IHCP reminds all providers about default ICD indicator on Web interChange
Providers must use the appropriate ICD Indicator and the appropriate ICD diagnosis codes when submitting claims via Web interChange. The ICD-9 indicator and ICD-9 diagnosis codes must be used for DOS before October 1, 2015. The ICD-10 indicator and the ICD-10 diagnosis codes must be used for DOS on or after October 1, 2015.
- PE approval letters serve as proof of temporary coverage
The State is aware that some members are presenting for pharmacy and other services before their PE status is visible to providers in the IHCP Eligibility Verification System or in the MCEs’ pharmacy benefits manager (PBM) systems. Please be aware that an original PE approval letter is sufficient to validate temporary coverage even if the member is not listed in the appropriate eligibility system.