It is important that you verify member eligibility on the date
of service every time you provide services. Viewing a member's ID
card alone does not ensure member eligibility, and neither does
having prior authorization on file.
The Indiana Health Coverage Programs (IHCP) historically has
provided the same card for all members regardless of the specific
IHCP program in which they enrolled. With the
implementation of new managed care programs, the managed care
entities have begun issuing cards for their enrolled members. MCE
cards will be issued as new members enroll in the plan or as lost
cards are replaced; therefore, some managed care members will
continue to carry the generic IHCP member card. Although MCE cards
will have a new look, they will continue to include the member's
IHCP recipient identification (RID) number for eligibility
verification purposes. See the Member Eligibility and Benefit
Coverage provider reference module for more
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 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, see the Web interChange
provider reference module.
Automated Voice Response (AVR)
The Automated Voice Response (AVR) system enables you to obtain
eligibility, basic claim status, and check write information
through the use of a touch-tone telephone. For instructions
about how to use AVR, see the Automated Voice Response
System provider reference module.
270/271 eligibility inquiry and response transaction - batch or
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