Policy Consideration Requests

The Indiana Health Coverage Programs (IHCP) has a specific process for members, providers, or other interested parties who would like to submit requests for policy consideration. A policy consideration request may seek to add coverage for specific medical codes, revise a provider code set, revise a current medical policy, or seek a resolution to a general question about Indiana Medicaid-covered services.

Note: If you are seeking reconsideration of a claim, see the Claims Administrative Review and Appeals provider reference module. If you are seeking reconsideration of a prior authorization request, please see the Prior Authorization provider reference module.

To submit a request, please email PolicyConsideration@fssa.in.gov and include a completed Policy Consideration Request Form. You may also attach additional information to support your request, if desired. Once the form has been submitted, the Policy Consideration Team will begin the review process. Do not send handwritten request forms.

Policy determinations can frequently be made within several weeks; however, more complex requests may require additional time. At any point throughout the process, you may email PolicyConsideration@fssa.in.gov to receive an update on your request.

Once a determination has been made, you will receive an email with the attached determination. If the request has been approved, you will be notified that the request is moving through the implementation process. If the request has been denied, you will receive an explanation for the decision. A denied request may be submitted for a new consideration following a period of 18 months from the date of the decision or on release of new studies that would support your request.

Please remember that approved policy consideration requests will not be applied retroactively.

Policy Consideration Request Form