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
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