Eligibility Verification

It is important that you verify member eligibility on the date of service every time you provide services. Viewing a member's ID card alone does not ensure member eligibility, and neither does having prior authorization on file.

The Indiana Health Coverage Programs (IHCP) historically has provided the same card for all members regardless of the specific IHCP program in which they enrolled. With the implementation of new managed care programs, the managed care entities have begun issuing cards for their enrolled members. MCE cards will be issued as new members enroll in the plan or as lost cards are replaced; therefore, some managed care members will continue to carry the generic IHCP member card. Although MCE cards will have a new look, they will continue to include the member's IHCP recipient identification (RID) number for eligibility verification purposes. See the Member Eligibility and Benefit Coverage provider reference module for more information.

If you fail to verify eligibility on the date of service, you risk claim denial if, for example, the member was not eligible on the date of service, or the service provided was outside the member's scope of coverage.

Any of the following eligibility verification tools can be used to verify the status of a member's eligibility for current and past dates of service.

Web interChange

Web interChange is a secure website that allows you to perform multiple functions including obtaining eligibility information, filing claims, and checking claim status. It is fast and easy to use. Online help is available through the eligibility verification process. For more information, see the Web interChange provider reference module.

Automated Voice Response (AVR)

The Automated Voice Response (AVR) system enables you to obtain eligibility, basic claim status, and check write information through the use of a touch-tone telephone. For instructions about how to use AVR, see the Automated Voice Response System provider reference module.

270/271 eligibility inquiry and response transaction - batch or interactive

The 270/271 eligibility benefit request and response is a Health Insurance Portability and Accountability Act (HIPAA)-compliant electronic transaction. For more information about electronic transactions, see EDI Solutions.