Provider Reference materials

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Medical Policy Manual

Name Effective Date Version
Medical Policy Manual October 2017 2.9

IHCP COMPANION GUIDES

For information about electronic transactions, HIPAA version 5010, see the IHCP Companion Guides page.


IHCP Provider Reference Modules

The IHCP Provider Reference Modules replace the former IHCP Provider Manual and supplemental provider manuals. For help finding information that has moved from the provider manuals to the IHCP Provider Reference Modules, see the IHCP Provider Manuals/Provider Reference Modules Crosswalk.

Jump to Eligibility and Benefits Modules
Jump to Claims and Billing Procedures Modules
Jump to Service- and Provider-Specific Modules
Jump to Program-Specific Modules

Effective Date* Version

General Information Modules

Introduction to the IHCP August 1, 2016 1.1
Interactive Voice Response System February 13, 2017 1.1
Prior Authorization May 1, 2017 2.0
Provider and Member Utilization Review September 1, 2017 2.0
Provider Enrollment October 1, 2016 1.1
Provider Healthcare Portal February 13, 2017 1.0

Eligibility and Benefits Modules

Member Eligibility and Benefit Coverage September 1, 2016 1.1
Presumptive Eligibility June 1, 2017 2.0
Presumptive Eligibility for Pregnant Women June 1, 2017 2.1
Right Choices Program February 13, 2017 1.1

Claims and Billing Procedures Modules

Claim Submission and Processing July 1, 2016 1.2
Claim Adjustments September 1, 2017 2.0
Claim Administrative Review and Appeals September 1, 2017 2.0
Electronic Data Interchange October 1, 2017 2.0
Financial Transactions and Remittance Advice September 1, 2017 2.0
HIPAA Standards for Electronic Transactions and Code Sets August 1, 2016 1.2
National Correct Coding Initiative September 1, 2017 2.0
Third Party Liability May 1, 2017 2.0

Service- and Provider-Specific Modules

Anesthesia Services July 1, 2017 2.0
Chiropractic Services May 1, 2017 2.0
Dental Services April 1, 2017 2.0
Diabetes Self-Management Training Services April 1, 2017 2.0
Durable and Home Medical Equipment and Supplies June 1, 2017 2.0
Early and Periodic Screening, Diagnosis, and Treatment (EPSDT)/HealthWatch April 1, 2017 2.0
Emergency Services September 1, 2017 2.0
Evaluation and Management Services April 1, 2017 2.0
Family Planning Services July 1, 2017 2.0
Federally Qualified Health Centers and Rural Health Clinics May 1, 2017 2.0
Genetic Testing May 1, 2017 2.0
Hearing Services June 1, 2017 2.0
Home and Community-Based Services Billing Guidelines September 1, 2016 1.1
Home Health Services May 1, 2017 2.0
Hospice Services May 1, 2017 2.0
Hospital Assessment Fee July 1, 2017 2.0
Injections, Vaccines, and Other Physician-Administered Drugs May 1, 2017 2.0
Inpatient Hospital Services September 1, 2017 2.0
Laboratory Services April 1, 2017 2.0
Long-Term Care April 1, 2017 2.0
Medicaid Rehabilitation Option Services September 7, 2016 1.1
Medical Practitioner Reimbursement April 1, 2016 1.2
Mental Health and Addiction Services April 1, 2016 1.2
Obstetrical and Gynecological Services May 1, 2017 2.0
Out-of-State Providers April 1, 2016 1.1
Outpatient Hospital and Ambulatory Surgical Center Services July 1, 2017 2.0
Pharmacy Services April 1, 2017 2.0
Podiatry Services April 1, 2016 1.2
Radiology Services September 1, 2017 2.0
Renal Dialysis Services September 1, 2017 2.0
School Corporation Services June 1, 2017 2.0
Surgical Services May 1, 2017 2.0
Telemedicine and Telehealth Services April 1, 2016 1.1
Therapy Services April 1, 2017 2.0
Transportation Services April 1, 2016 1.2
Vision Services April 7, 2017 2.0

Program-Specific Modules

590 Program February 13, 2017 1.1
Division of Aging
Home and Community-Based Services Waivers
April 1, 2017 5.0
Division of Disability and Rehabilitative Services
Home and Community-Based Services Waivers
April 1, 2017 5.0
Division of Mental Health and Addiction
Adult Mental Health Habilitation Services
May 1, 2017 2.0
Division of Mental Health and Addiction
Behavioral and Primary Healthcare Coordination Services
May 1, 2017 4.0
Division of Mental Health and Addiction
Child Mental Health Wraparound Services
June 1, 2017 2.0
Division of Mental Health and Addiction
Psychiatric Residential Treatment Facility Transition Waiver
May 1, 2016 4.0
Family Planning Eligibility Program July 1, 2017 2.0
Healthy Indiana Plan 2.0 Pending

The effective date indicates the date of the policies and procedures included in this version of the module. Some modules also include terminology and procedural updates related to the implementation of the new CoreMMIS on February 13, 2017.