Provider Reference materials

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Medical Policy Manual

Name Effective Date Version
Medical Policy Manual May 2018 2.11

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 June 1, 2017 2.0
Interactive Voice Response System October 1, 2017 2.0
Prior Authorization February 1, 2018 3.0
Provider and Member Utilization Review March 1, 2018 3.0
Provider Enrollment April 1, 2018 3.0
Provider Healthcare Portal March 1, 2018 3.0

Eligibility and Benefits Modules

Member Eligibility and Benefit Coverage March 1, 2018 3.0
Presumptive Eligibility February 1, 2018 3.0
Right Choices Program October 1, 2017 2.0

Claims and Billing Procedures Modules

Claim Submission and Processing April 1, 2018 3.0
Claim Adjustments March 1, 2018 3.0
Claim Administrative Review and Appeals September 1, 2017 2.0
Electronic Data Interchange April 1, 2018 3.0
Financial Transactions and Remittance Advice September 1, 2017 2.0
National Correct Coding Initiative September 1, 2017 2.0
Third Party Liability February 1, 2018 3.0

Service- and Provider-Specific Modules

Anesthesia Services July 1, 2017 2.0
Chiropractic Services May 1, 2017 2.0
Dental Services April 1, 2018 3.0
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 October 1, 2017 2.0
Home Health Services May 1, 2017 2.0
Hospice Services May 1, 2017 2.0
Hospital Assessment Fee April 1, 2018 3.0
Injections, Vaccines, and Other Physician-Administered Drugs May 1, 2018 3.0
Inpatient Hospital Services September 1, 2017 2.0
Laboratory Services May 1, 2018 3.0
Long-Term Care February 1, 2018 3.0
Medical Practitioner Reimbursement October 1, 2017 2.0
Mental Health and Addiction Services May 1, 2017 2.0
Obstetrical and Gynecological Services May 1, 2017 2.0
Out-of-State Providers July 1, 2017 2.0
Outpatient Facility Services May 1, 2018 3.0
Pharmacy Services February 1, 2018 3.0
Podiatry Services October 1, 2017 2.0
Radiology Services September 1, 2017 2.0
Renal Dialysis Services September 1, 2017 2.1
School Corporation Services March 1, 2018 3.0
Surgical Services May 1, 2017 2.0
Telemedicine and Telehealth Services October 1, 2017 2.0
Therapy Services April 1, 2017 2.0
Transportation Services October 1, 2017 2.0
Vision Services April 7, 2017 2.0

Program-Specific Modules

590 Program October 1, 2017 2.0
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
July 1, 2018 3.0
Division of Mental Health and Addiction
Behavioral and Primary Healthcare Coordination Services
July 1, 2018 5.0
Division of Mental Health and Addiction
Child Mental Health Wraparound Services
July 1, 2018 3.0
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
Medicaid Rehabilitation Option Services September 1, 2017 2.0
Healthy Indiana Plan February 1, 2015 1.0

The effective date indicates the date of the policies and procedures included in this version of the module.