IHCP extends deadline to update rendering provider linkages for proper claim adjudication to January 1, 2018

IHCP extends deadline to update rendering provider linkages to January 1, 2018

In numerous publications, the Indiana Health Coverage Programs (IHCP) has reminded providers that correct rendering/group provider linkages are essential to the proper adjudication of rendering provider claims. Claims billed for services performed by rendering providers not linked to the specific service location on the claim deny for 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.

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.

In banner page BR201719, the IHCP announced that EOB 1010 would temporarily be converted to a "post-and-pay" status to allow providers time to submit enrollment updates to appropriately link rendering providers to group locations. A "post-and-pay" status means the claim-processing system allows claims and claim details with this issue to pay, even though the EOB 1010 message continues to post on the Remittance Advice (RA). This temporary conversion was originally scheduled to end as of August 31, 2017. The IHCP is extending this temporary workaround through December 31, 2017. Effective January 1, 2018, the EOB 1010 edit will revert to a denial status.

Providers should review their RAs in detail, note any EOB 1010s, and update rendering providers in service location profiles, as necessary. Providers are encouraged to submit these updates as soon as possible to allow for processing before January 1, 2018.