Provider Reference materials

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Medical Policy Manual

Name Effective Date Version
Medical Policy Manual April 2017 2.7

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 July 1, 2016 1.2
Provider and Member Utilization Review August 1, 2016 1.1
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
Hospital Presumptive Eligibility August 1, 2016 1.2
Presumptive Eligibility August 1, 2016 1.2
Presumptive Eligibility for Pregnant Women July 1, 2016 1.2
Right Choices Program February 13, 2017 1.1

Claims and Billing Procedures Modules

Claim Submission and Processing July 1, 2016 1.2
Claim Adjustments August 1, 2016 1.1
Claim Administrative Review and Appeals August 1, 2016 1.2
Electronic Data Interchange September 1, 2016 1.1
Financial Transactions and Remittance Advice August 1, 2016 1.1
HIPAA Standards for Electronic Transactions and Code Sets August 1, 2016 1.2
National Correct Coding Initiative August 1, 2016 1.1
Third Party Liability July 1, 2016 1.2

Service- and Provider-Specific Modules

Anesthesia Services April 1, 2016 1.2
Chiropractic Services April 1, 2016 1.1
Dental Services April 1, 2016 1.3
Diabetes Self-Management Training Services April 1, 2016 1.2
Durable and Home Medical Equipment and Supplies April 1, 2016 1.2
Early and Periodic Screening, Diagnosis, and Treatment (EPSDT)/HealthWatch April 1, 2016 1.2
Emergency Services April 1, 2016 1.3
Evaluation and Management Services April 1, 2016 1.1
Family Planning Services April 1, 2016 1.1
Federally Qualified Health Centers and Rural Health Clinics April 1, 2016 1.2
Genetic Testing April 1, 2016 1.1
Hearing Services April 1, 2016 1.2
Home and Community-Based Services Billing Guidelines September 1, 2016 1.1
Home Health Services April 1, 2016 1.4
Hospice Services April 1, 2016 1.2
Hospital Assessment Fee April 1, 2016 1.2
Injections, Vaccines, and Other Physician-Administered Drugs April 1, 2016 1.2
Inpatient Hospital Services April 1, 2016 1.2
Laboratory Services April 1, 2016 1.1
Long-Term Care April 1, 2016 1.2
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 April 1, 2016 1.2
Out-of-State Providers April 1, 2016 1.1
Outpatient Hospital and Ambulatory Surgical Center Services April 1, 2016 1.2
Pharmacy Services April 1, 2016 1.2
Podiatry Services April 1, 2016 1.2
Radiology Services April 1, 2016 1.1
Renal Dialysis Services April 1, 2016 1.2
School Corporation Services April 1, 2016 1.1
Surgical Services April 1, 2016 1.2
Telemedicine and Telehealth Services April 1, 2016 1.1
Therapy Services April 1, 2016 1.1
Transportation Services April 1, 2016 1.2
Vision Services April 1, 2016 1.2

Program-Specific Modules

590 Program February 13, 2017 1.1
Division of Aging
Home and Community-Based Services Waivers
April 1, 2016 4.1
Division of Disability and Rehabilitative Services
Home and Community-Based Services Waivers
April 1, 2016 4.1
Division of Mental Health and Addiction
Adult Mental Health Habilitation Services
May 1, 2016 1.3
Division of Mental Health and Addiction
Behavioral and Primary Healthcare Coordination Services
June 1, 2016 3.1
Division of Mental Health and Addiction
Child Mental Health Wraparound Services
June 1, 2016 1.3
Division of Mental Health and Addiction
Psychiatric Residential Treatment Facility Transition Waiver
May 1, 2016 4.0
Family Planning Eligibility Program April 1, 2016 1.2
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.