Indiana's New CoreMMIS Billing Guidelines

As the Indiana Health Coverage Programs (IHCP) replaces its current Medicaid Management Information System (MMIS), IndianaAIM, with the new CoreMMIS beginning December 5, 2016, there are several things providers should know as they prepare to make the change in their own billing procedures.

In addition to registering their service locations on the new Portal (see instructions in a previous CIPROMS blog post), providers should review their own billing protocols to be sure they comply with IHCP and nationally accepted billing guidelines. Many of the IHCP billing guidelines will remain the same on the new CoreMMIS. However, a few will change, as outlined below:

HIPAA-compliant coding will apply to all claims processed in CoreMMIS. An exception exists only for occurrence codes billed on claims with dates of service (DOS) before December 5, 2016. Providers should follow previous IHCP billing guidance regarding occurrence codes on claims for DOS before December 5, 2016.
With the implementation of CoreMMIS, providers will be required to submit third-party liability (TPL) information and Medicare information at the detail level on Medical crossover, Outpatient crossover, and Home health crossover claims. Providing this information at the detail level gives a more accurate accounting of claim reimbursement and also is more consistent with how TPL and Medicare information is processed within the larger healthcare industry. The claim types that will require TPL information at the detail level include: Medical, Dental, Home health, and Outpatient. See CoreMMIS Bulletin 201667 for more information about crossover claims in CoreMMIS.
CoreMMIS will apply all National Correct Coding Initiative (NCCI) edits as well as all IHCP enhanced code auditing rules directly through its claim-processing rules. As such, McKesson will no longer serve as a contracted vendor for the NCCI editing and code auditing functions. With the enhanced NCCI editing in CoreMMIS, IHCP providers will see new explanation of benefits (EOBs) codes associated with claim adjudication. Review CoreMMIS Bulletin 201667 for a complete list of those EOB codes and descriptions.
Effective with CoreMMIS implementation, the IHCP will apply Centers for Medicare and Medicaid (CMS) guidelines when reimbursing for bilateral procedures. Reimbursement for the procedure codes will be based on the CMS National Physician Fee Schedule (NPFS) Relative Value File status indicators shown in Table 2 of CoreMMIS Bulletin 201669.
Presumptive Eligibility will continue mostly unchanged on the new CoreMMIS. However, member identification numbers may vary depending on previous numbers issued by IHCP. The November 30, 2016, member eligibility file from Indiana Client Eligibility System (ICES) will be the final eligibility update made in IndianaAIM. The update will be made by 6 a.m. on December 1, 2016. The first member eligibility file update in CoreMMIS will include ICES files from December 1-3, 2016, and will occur by 6 a.m. on December 5, 2016, before CoreMMIS implementation. See CoreMMIS Bulletin 201670 for more information about the details of the PE transition.
As part of the transition to CoreMMIS, IHCP also will temporarily suspend acceptance of all applications for EHR adoption, implementation, upgrade, or meaningful use from November 18 through December 11. Access to the Medical Assistance Provider Incentive Repository (MAPIR) will be available in the current system through Thursday, November 17, 2016, and will be available via the new Portal beginning Monday, December 12, 2016.

During CoreMMIS implementation, seven years of claims information from IndianaAIM will be converted to CoreMMIS. Providers can access past claims information through their Provider Portal accounts linked to the provider’s Provider ID. (A Provider ID consists of the provider’s Legacy Provider Identifier and the service location code.)

Although all viewable claim information will be available in the Portal, claims processed in IndianaAIM that are converted to CoreMMIS will have new claim identification numbers (Claim IDs). ICNs assigned by IndianaAIM will no longer be used. While providers will not be able to search for old claims processed using the old ICN, they will be able to search on other criteria like member ID, date of service, and so on to retrieve claims information. CoreMMIS Bulletin 201671 includes more information about searching for claims on the new CoreMMIS.

For more information about the transition to CoreMMIS, visit the Indiana CoreMMIS webpage, which also has links to all the CoreMMIS bulletins.