IHCP addresses problems with MRO, AMHH, BPHC, and CMHW benefit packages

With the implementation of CoreMMIS, the Indiana Health Coverage Programs is aware of various challenges associated with member benefit packages for Medicaid Rehabilitation Option (MRO), Adult Mental Health Habilitation (AMHH), Behavioral and Primary Healthcare Coordination (BPHC), and Child Mental Health Wraparound (CMHW) services. The following outlines the current status of the identified issues.

MRO, AMHH, BPHC, and CMHW benefit packages not being created for members with approved services

  • MRO services: This issue has been resolved for MRO members - both current and future. The files to create the accurate MRO benefit packages for current members have been reprocessed and should be visible in the Provider Healthcare Portal (Portal).
  • AMHH, BPHC, and CMHW services: This issue has been resolved for AMHH, BPHC, and CMHW newly enrolling members moving forward; however, the IHCP is working with the Division of Mental Health and Addiction (DMHA) to create accurate benefit packages for members whose files were previously denied. Once completed, the package updates will be visible in the Portal. In addition, providers will receive error-and-response files when the records for the previously denied packages are reprocessed.

MRO and BPHC benefit package effective and end dates not in line with approved dates, due to errors in converting prior authorization (PA) files

  • MRO and BPHC services: This issue has been resolved. Adjustments have been made to benefit package effective and end dates, and correct information should be visible in the Portal. This issue did not impact AMHH or CMHW benefit packages.

MRO, AMHH, BPHC, and CMHW benefit packages were created incorrectly when member's eligibility was end-dated and then reinstated, resulting in overlapping PAs

  • CMHW services: Updates to the system for CMHW members are pending. Please monitor future IHCP publications for an update on the policy for CMHW services when a member's Medicaid has been end-dated and reinstated.
  • MRO, AMHH, and BPHC services: Updates to CoreMMIS have been applied so that, moving forward, the system will accurately create benefit packages for MRO, AMHH, and BPHC services when a member's Medicaid eligibility has been reinstated. However, the IHCP continues to work with the DMHA to correct benefit packages for members whose files were originally rejected due to the system issues and overlapping PAs.

    Records received from the DMHA that were originally rejected will be reprocessed to create the appropriate benefit packages. The IHCP will evaluate and address claim issues on a case-by-case basis for benefit packages that have been reprocessed. Once completed, the package updates will be visible in the Portal. After the rejected records have been reprocessed, an error-and-response report will be generated and sent to providers.

    Providers should be aware that a new MRO package processing system error code has been created to prevent duplication of packages. The new error code, 1676 - MRO PA already exists for all/part of the service dates, will appear on the error report should an existing PA already exist for all or part of the service dates.

Watch future IHCP provider publications for additional updates on issues that remain outstanding.