- 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.
- IHCP identifies claims processing error
A claims processing error that affected claims submitted for payment the week of June 20, 2016, has been identified. A system error prevented claim payments from processing and subsequent posting to Web interChange and 835 Remittance Advices (RAs). The error has been corrected. Claims submitted June 20, 2016, to June 28, 2016, will be processed during the next financial cycle. Providers should begin to see the processed claims on RAs beginning July 5, 2016.
- 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.
- Provider Audit Workgroup to hold public hearings in July
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 hold three public hearings in July to solicit input from interested parties on this topic. See full article for more details.
- EHR Program Year 2015 MU Attestations to begin July 11
Indiana will begin accepting Program Year 2015 Meaningful Use (MU) attestations for Eligible Professionals (EPs) July 11, 2016, when an upgrade to the Medical Assistance Provider Incentive Repository (MAPIR) will be completed. Please do not submit your attestation until July 11, 2016, or after to ensure that the MAPIR upgrade is complete. Any EP Program Year 2015 attestation started in MAPIR before the upgrade is complete will be aborted and will have to be restarted after the system upgrade.
- New CMS rule modifies EHR meaningful use for 2015
In October, the CMS released a final rule (with comment period), specifying the criteria that eligible professionals (EPs) and eligible hospitals and critical access hospitals (EH/CAHs) must meet to demonstrate meaningful use of EHR. These changes encompass modifications to the program for 2015-2017 (Modified Stage 2), as well as Stage 3 in 2018 and beyond. Updates to the MAPIR will be required, which will affect submission of all meaningful use applications.
- 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.