Eligibility Verification

It is important that you verify member eligibility on the date of service. Viewing a Hoosier Health Card alone does not ensure member eligibility; neither does having prior authorization on file.

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.

Any of the following eligibility verification tools can be used to verify the status of a member's eligibility for current and past dates of service.

Web interChange

Web interChange is a secure website that allows you to perform multiple functions including obtaining eligibility information, filing claims, and checking claim status. It is fast and easy to use. Online help is available through the eligibility verification process. For more information, please see Chapter 3 of the IHCP Provider Manual.

Automated Voice Response (AVR)

The Automated Voice Response (AVR) system enables you to obtain eligibility, basic claim status, and checkwrite information through the use of a touch-tone telephone. For instructions about how to use AVR, please read Chapter 3 of the IHCP Provider Manual.

270/271 eligibility inquiry and response transaction - batch or interactive

The 270/271 eligibility benefit request and response is a Health Insurance Portability and Accountability Act (HIPAA)-compliant electronic transaction. For more information about electronic transactions, see EDI Solutions.

More information

For more information, see the following chapters of the IHCP Provider Manual: