CoreMMIS and the new Provider Healthcare Portal coming
In early 2016, the Indiana Health Coverage Programs (IHCP)
information processing system, IndianaAIM, will be
replaced with a new system called CoreMMIS, which stands
for Core Medicaid Management Information System. Along with
CoreMMIS, a new provider interface called the Provider
Healthcare Portal will replace Web interChange. The IHCP has
established an Indiana CoreMMIS web page as
a reference point for posting information about the new system and
the provider portal. Special CoreMMIS bulletins will be
published and posted to this web page to communicate important
system details and transition plans.
News and Announcements
- 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 transportation providers about ICD-9 vs ICD-10 requirements
Transportation providers must use the appropriate ICD indicator and the appropriate ICD diagnosis codes when submitting paper claims and 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.
- 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.
- Pharmacy Benefit Manager, Catamaran, joins with OptumRx
On July 23, 2015, the Indiana Health Coverage Program’s (IHCP’s) fee-for-service (FFS) Pharmacy Benefit Manager (PBM), Catamaran, combined with Optum’s pharmacy care services business, OptumRx. The combination of Catamaran and OptumRx will operate as OptumRx. Providers will begin to see communications and related PBM material referring to OptumRx as the IHCP FFS Pharmacy Benefit Manager.
- 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.