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4 Things to Know About Indiana Medicaid for 2021

4 Things to Know About Indiana Medicaid for 2021

As we begin 2021, the Indiana Health Coverage Programs (IHCP) has released a variety of information Indiana healthcare providers need to know about billing Medicaid in the new year. We’ve created a short list of the top four things you should know.

New Enrollment Fee

Beginning January 1, 2021, the IHCP providers subject to the enrollment application fee will be required to pay $599 with initial enrollments, including changes of ownership and enrollment revalidations. Applications submitted online or with a postmark of January 1, 2020, or later must pay $599.

To see which providers are subject to the enrollment application fee, review the IHCP Provider Enrollment Risk Category and Application Fee Matrix.

2021 Annual HCPCS Update Delayed

The IHCP has experienced a delay in obtaining the 2021 list of Healthcare Common Procedure Coding System (HCPCS) and Current Procedural Terminology (CPT®1) code updates from the Centers for Medicare & Medicaid Services (CMS). As a result of the delay, the IHCP was unable to publish coverage, prior authorization, and reimbursement information for newly released codes by January 1, 2021. 

The IHCP intends to publish all information by February 1, 2021, and will prioritize any coronavirus disease 2019 (COVID-19)-related codes for publication in advance of any other determinations. Any covered codes published after the national effective date will be retroactively covered to their national effective date.

For more information about the delay, check out the IHCP Bulletin BT2020125.

FSSA Selects Managed Care Entities to Serve Hoosier Care Connect Members

The Indiana Family and Social Services Administration’s (FSSA) Office of Medicaid Policy and Planning (OMPP) recently announced the procurement of three managed care entities (MCEs) that will serve members in the Hoosier Care Connect program beginning April 1, 2021. As a result of the procurement process, the FSSA has begun negotiation with three selecte MCEs: Anthem, Managed Health Services (MHS), and UnitedHealthcare. UnitedHealthcare as the newest MCE to help coordinate care for Hoosier Care Connect members.

Hoosier Care Connect is a healthcare program for individuals who are aged 65 and older, blind or disabled, and not eligible for Medicare. To participate in the Hoosier Care Connect MCE networks, providers must be enrolled with the Indiana Health Coverage Programs (IHCP) and be contracted with one or more of the MCEs. Providers currently contracted with an existing MCE may be required to enter into new contracts to remain in-network as of April 1, 2021. Providers should contact the MCE directly for further direction.

Providers can direct questions to the MCEs about their credentialing and contracting processes.

Check out IHCP Bulletin BT2020124 for more details about the selected MCEs.

IHCP to Reimburse Pharmacy Providers for COVID-19 Vaccine Administration

Effective immediately, the IHCP will reimburse IHCP enrolled pharmacy providers for coronavirus disease 2019 (COVID-19) vaccinations. This includes pharmacist-ordered COVID-19 vaccines administered by qualified pharmacists or pharmacist-supervised pharmacy interns or technicians. 

Vaccinations can be administered to all eligible IHCP members meeting vaccine Emergency Use Authorization (EUA) criteria and any additional requirements or limitations specified by the Indiana Department of Health or the Centers for Disease Control and Prevention (CDC). See the Health and Human Services (HHS) Guidance regarding Public Readiness and Emergency Preparedness (PREP) Act Coverage.

Check out IHCP Bulletin BT2020127 for more details about how to submit claims for these services.

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Charity Singleton Craig

Charity Singleton Craig is a freelance writer and editor who provides communications and marketing services for CIPROMS. She is responsible for creating, editing, and managing all content, design, and interaction on the company website and social media channels in order to promote CIPROMS as a thought leader in healthcare billing and management.

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