IHCP allows providers until September 1, 2017, to update rendering provider linkages

IHCP allows providers until September 1, 2017, to update rendering provider linkages

The Indiana Health Coverage Programs (IHCP) has received a number of inquiries from providers about claim denials for explanation of benefits (EOB) 1010 - Rendering provider is not an eligible member of billing group or the group provider number is reported as rendering provider. Please verify provider and resubmit. As announced in previous IHCP publications, claims billed for services performed by a rendering provider not linked to the specific service location on the claim will deny for EOB 1010.

IHCP policy requires rendering providers to be linked to the specific locations where they render services for a group practice. Further, a rendering provider's services may not be billed for a service location to which he or she is not linked. Group providers must ensure that the provider profile for each group location has the correct rendering providers linked with accurate effective and end dates.

To provide financial relief to providers impacted by EOB 1010 denials, the IHCP will temporarily convert EOB 1010 to a "post-and-pay" status, meaning that the system will allow claims and claim details with this issue to pay, but the EOB 1010 message will continue to post on the RA, so providers are aware the problem exists. This temporary workaround will be in place through August 31, 2017, allowing providers ample time to link rendering providers to the appropriate group locations to support proper claims adjudication. Effective September 1, 2017, the EOB 1010 will revert to a denial status.

Providers should review their RAs in detail, note any EOB 1010 messages, and make the necessary rendering provider updates to the affected service location profiles. Providers are encouraged to submit rendering linkage updates as soon as possible, to allow for processing before September 1, 2017.

Watch upcoming IHCP publications for instructions on viewing and updating rendering providers in the Provider Healthcare Portal.