PE approval letters serve as proof of temporary coverage

Presumptive eligibility (PE) allows qualifying individuals to receive temporary health coverage under the Indiana Health Coverage Programs (IHCP) until official eligibility can be determined by the Indiana Family and Social Services Administration (FSSA). This temporary eligibility allows members to gain access to services immediately and allows providers to be paid for services rendered. PE coverage is temporary and lasts for up to 60 days. To continue coverage, members are required to complete and submit an Indiana Application for Health Coverage and be found eligible.

Members who are found eligible through the PE process receive letters that serve as proof of coverage during their PE period. These members do not receive IHCP member identification cards. The letter clearly indicates the dates the member's PE period begins and ends, the member's recipient identification number (RID), and if applicable, the member's managed care entity (MCE). Please be aware that an original PE approval letter is sufficient to validate temporary coverage even if the member is not listed in the appropriate eligibility system. See the sample PE approval letter provided for your reference.

The State is aware that some members are presenting for pharmacy and other services before their PE status is visible to providers in the IHCP Eligibility Verification System or in the MCEs' pharmacy benefits manager (PBM) systems. This is a particular concern with point-of-sale pharmacy providers as it may take up to three days for members' eligibility to be visible in PBM systems. Pharmacy providers should contact the member's MCE regarding claims submission. The IHCP is working to develop better processes that will allow members' PE eligibility to be loaded into systems more quickly.