Right choices program (RCP)
The Right Choices Program monitors member utilization and, when
appropriate, implements restrictions for members who would benefit
from increased case coordination. Member utilization review
identifies members who use Indiana Health Coverage Programs (IHCP)
services more extensively than their peers.
Any Medicaid member who meets the RCP criteria may be enrolled
in RCP regardless of whether the member is in Hoosier Healthwise,
Healthy Indiana Plan (HIP), Hoosier Care Connect, or
Traditional Medicaid. Anthem, MHS, MDwise, and
Cooperative Managed Care Services (CMCS)
administer the RCP for their members in accordance with the
State's policy and procedure guidelines.
Each RCP member is restricted to a physician, a pharmacy, and a
hospital. In some situations, the member can be restricted to
additional provider types, if such action is warranted. For
example, the RCP member's lock-in physician can refer the member
to a specialist. That specialist is then added to the
member's list of providers. In an emergency, other providers can
render services without the need for a referral.
Information received when checking eligibility
Because there are multiple vendors performing RCP administration
duties, providers must verify member eligibility to determine
to which Medicaid program or plan the member belongs.
The provider is responsible for checking the eligibility of IHCP
members before rendering services. If no restrictions are listed,
the member is not restricted to any specific provider. If the
eligibility response lists restrictions, the member is restricted
to receiving specific types of services only from the specific
The IHCP reimburses only the providers to which the member is
restricted unless a referral is on file at the entity to which the
member is assigned, or if the service is for an emergency
condition. The provider must notify the member, before rendering
the service, that the services will not be covered by the IHCP and
ask the member to sign a statement of understanding that he or she
is responsible for payment. The provider can bill the member for
the services not eligible for payment due to the RCP restrictions.
Claims for nonemergency services to a Right Choices member that are
rendered by a provider that is not assigned or referred are
Providers may refer questions about RCP members to contacts
noted on the IHCP Quick Reference Guide.
For more information, see the following provider reference
• Right Choices
• Provider and Member Utilization
• Member Eligibility and Benefit
• Automated Voice Response