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 managed care programs, the managed care entities
(MCEs) 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 Member ID (or RID) for eligibility verification purposes. See
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.
The following eligibility verification tools can be used to
verify the status of a member's eligibility for current and past
dates of service.
IHCP Provider Healthcare Portal
The Provider Healthcare
Portal is a secure website that allows you to perform multiple
functions including obtaining eligibility information and filing
fee-for-service (FFS) claims. The Portal is fast and easy to use,
and online help is available through the eligibility verification
process. For more information, see the Provider Healthcare
Portal provider reference module.
Interactive Voice Response (IVR) System
The Interactive Voice Response (IVR) System enables you to
obtain member eligibility, basic FFS claim status, and other
routine information through the use of a touch-tone telephone.
For instructions about how to use IVR System, see
the Interactive Voice Response
System provider reference module on the Provider Reference
Materials page of this website.
270/271 eligibility inquiry and response transaction - batch or
The 270/271 eligibility benefit request and response is a
Health Insurance Portability and Accountability Act
(HIPAA)-compliant electronic transaction for use by registered
trading partners. For more information about electronic
transactions, see EDI Solutions