News Summary

  • IHCP clarifies NEMT assignment information on Portal eligibility panels

    06/14/2018 - Beginning June 1, 2018, when verifying member eligibility, providers saw "Southeastrans" displayed under the Managed Care Assignment Details panel for fee-for service (FFS) members whose nonemergency medical transportation (NEMT) benefits are managed through Southeastrans. It is critical providers understand that this managed care assignment applies to NEMT services ONLY; the member continues to receive other services as FFS.

  • IHCP corrects claim submission process for FFS NEMT

    06/13/2018 - Previously issued billing guidance for transportation providers rendering nonemergency medical transportation (NEMT) services to fee-for-service (FFS) members brokered through Southeastrans (SET), included errors. Providers other than emergency medical services (EMS) providers, should NOT bill using a CMS-1500 claim form, as previously instructed. See the full news item for corrected guidance.

  • IHCP notifies providers where to find NEMT eligibility information in the Provider Healthcare Portal

    06/01/2018 - With the implementation of Southeastrans as the IHCP non-emergency medical transportation (NEMT) broker, the IHCP has enhanced the eligibility feature of the Provider Healthcare Portal. As of June 1, 2018, providers will see Southeastrans listed under the Managed Care Assignment Details panel in the Portal for all fee-for-service (FFS) members who are eligible to receive non-emergency transportation services through Southeastrans.

  • IHCP will implement a transition period for brokered NEMT services

    05/23/2018 - The IHCP is working with Southeastrans Inc. to streamline the way fee-for-service (FFS) members arrange NEMT services effective June 1, 2018. To ensure a smooth execution of the program, the IHCP will implement a 30-day transition period from June 1, 2018, to June 30, 2018. During this time, IHCP-enrolled transportation providers that accept ride requests directly from members, but are not yet contracted with SET, can work with SET to obtain reimbursement. See full article.

  • Medicare Part D prescription drug copayment issue corrected

    04/12/2018 - Some Medicare Part D prescription drug copayments calculated incorrectly beginning January 1, 2018. As a result, certain IHCP members dually eligible for Medicaid and Medicare were asked to pay higher copayments for their prescriptions than should have been required. The Medicare Part D copayment issue has been corrected. Medicare Part D Plans will work with PBMs and pharmacies to ensure claim adjustments are made so that pharmacies and members are reimbursed appropriately.

  • Taxonomy codes for rendering providers not required on claims

    11/17/2017 - The IHCP reminds providers that taxonomy codes for rendering providers are not required on claims. If a taxonomy code for a rendering provider is submitted on a claim, the taxonomy code will not be validated. National Provider Identifiers (NPIs) for rendering providers are still required on all fee-for-service (FFS) and managed care claims.

  • IHCP implements taxonomy code requirement changes

    11/14/2017 - The IHCP will implement the changes to taxonomy code requirements for attending, operating, and OPR providers announced in BT201768, effective November 29, 2017. As stated in BT201768, these changes apply to all fee-for-service (FFS) and managed care claims, regardless of submission format, and are retroactive to dates of claim submission on or after February 13, 2017.

  • IHCP reminds providers how to interpret PA status information

    07/25/2017 - As stated in BR201715, PA status codes displayed on the Portal and used in the IVR comply with the HIPAA 278 transaction standards and provide only a high-level, standardized description of the actual working status of the PA request. To help providers, the IHCP has created a crosswalk table showing the standard response categories reported on the Portal and through the IVR with the administrative working statuses associated with each standard response category.