Indiana Medicaid group providers have until the end of January to be sure they’re properly linked to all service locations where they practice. Beginning January 1, 2018, services billed at locations that are not linked to a provider’s enrollment record will be denied.
According to Indiana Health Coverage Programs, Medicaid policy requires rendering providers be linked to the specific location(s) where they render services for a group practice. Further, rendering providers may not bill for services at a service location to which they are not linked. It is up to group providers to ensure that the provider profile for each group location has the correct rendering providers linked with accurate effective and end dates.
While this is not a new policy, in IHCP’s old claims systems, IndianaAIM, processing rules did not edit for a specific service location linkage when processing claims. Instead, that system simply verified that the rendering provider was linked to any service location. In the new CoreMMIS, which was implemented in early 2017, however, claims billed by a rendering provider who is not linked to the service location identified on the claim will be denied.
In the immediate months following the implementation of CoreMMIS, so many providers were receiving denial EOB 1010—Rendering provider is not an eligible member of billing group or the group provider number is reported as rendering provider. Please verify provider and resubmit—that IHCP temporarily converted it to a “post-and-pay” status through August 31, 2017. In early August, that deadline was extended to December 31, 2017.
Now, IHCP seems committed to switching denial code EOB 1010 to a true denial for any claims without the proper provider service location linkage on January 1, 2018. If you have not received any EOB 1010 denials in your Indiana Medicaid Remittance Advices over the past few months, then your provider/service location linkages are likely correct. However, if you have received EOB 1010 denials or if you simply want to confirm that your providers and service locations are correctly linked, IHCP Banner Page BR201731 has instructions for viewing, adding, and changing the linkages. (This training webinar “Provider Healthcare Portal: Online Enrollment” also should help.)
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