In July 2017, the Indiana Health Coverage Programs (IHCP) announced a delay in provider enrollment for its various Indiana Medicaid programs, citing system changes and a large volume of provider enrollment applications, revalidations, and profile updates. On October 10, IHCP reported that they have reduced the backlog and currently are processing normal levels of enrollment “inventory.”
As IHCP gets back on track with processing new enrollments, revalidations, and other enrollment transactions, here are a few tips from CIPROMS Director of Provider Enrollment Denise O’Brien for staying ahead of the game in enrolling providers in Indiana Medicaid.
1. Begin the enrollment process as early as possible. The sooner you begin the enrollment process (whether you are doing it yourself or working through a third party billing company or consultant), the sooner the practitioner can begin to treat patients and bill Indiana Medicaid for those services.
2. Apply for a retroactive enrollment date if the provider begins to see patients before the application is received by Indiana Medicaid. According to the Indiana Medicaid Provider Enrollment Reference Module, the enrollment effective start date for providers is the date the Provider Enrollment Unit receives the completed IHCP provider packet or online enrollment application. Medicaid will consider a retroactive enrollment date up to 12 months prior to the application received date if the services rendered were compliant with Medicaid guidelines and the provider was enrolled with Medicare on the requested date. However, an individual provider’s effective date cannot be earlier than the effective date of the group he is linked to.
3. Have your enrollment application packets for Indiana Medicaid MCEs ready. Though you can’t enroll providers with these plans until they have a confirmed enrollment with Indiana Medicaid, having the application packets ready will allow you to enroll as soon as possible once you get the notification. Keep in mind that the filing limit for MCEs is only 90 days (compared to one year for Indiana Medicaid).
4. Submit Indiana Medicaid enrollment applications electronically if possible through IHCP’s Provider Healthcare Portal, the provider interface for the new CoreMMIS. According to IHCP, electronic transactions offer the following benefits: they are processed more efficiently than paper submissions, they reduce errors in initial submissions, and they generate an application tracking number (ATN) to help track the application and submit additional documentation that may be requested.
5. Regularly check the eligibility status of provider enrollments you are waiting on. While Indiana Medicaid should send a letter and/or email indicating when the enrollment has been confirmed, it’s a good idea to keep tabs on outstanding requests in case the letter is delayed. For instance, the CIPROMS enrollment department checks on outstanding applications weekly until enrollment has been confirmed.
IHCP recommends checking the status of your transaction as follows:
- For transactions submitted through the Provider Healthcare Portal, check the status of the transaction in the Portal using the ATN.
- For paper transactions, check the status of the transaction by calling Customer Service at 1-800-457-4584. You’ll need to provide your NPI, as well as the legal and “doing business as” (DBA) name on the transaction.
6. Double check the effective dates once enrollment is confirmed. Though Indiana Medicaid says the enrollment effective date will be the date they received the application, in some instances, especially during the recent backlog, eligibility effective dates have erroneously been recorded as several weeks after the receipt date.
With documented proof, you can appeal these dates with Indiana Medicaid’s Provider Enrollment Unit. Online enrollments should be timestamped with the date received. For paper enrollment submissions, be sure to send them by certified mail so you have a record of the date the Indiana Medicaid office received them.
7. Hold claims until enrollment and the correct effective date have been confirmed. This is the simplest way to avoid receiving denials and refiling claims. If you do file claims before a provider is enrolled, be sure to keep track of any denials and refile the claims once the enrollment and effective date are settled.
For more information, review the Indiana Medicaid Provider Enrollment Reference Module, sign up to receive IHCP news bulletins (and review the archive of previous announcements), or call the IHCP Customer Service line at 1-800-457-4584.
— All rights reserved. For use or reprint in your blog, website, or publication, please contact us at firstname.lastname@example.org.