UPDATED: This temporary conversion was originally scheduled to end as of August 31, 2017. The IHCP is extending this temporary workaround through December 31, 2017. Effective January 1, 2018, the EOB 1010 edit will revert to a denial status.
Have you received unexpected denials from your Indiana Medicaid claims with EOB code 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”? It’s not a mistake, at least not on the part of Indiana Health Coverage Programs (IHCP), but they are offering providers a grace period to make the necessary corrections.
Here’s the problem. With the implementation of the Indiana Health Coverage Programs’ (IHCP) new Core Medicaid Management Information System (CoreMMIS) and Provider Healthcare Portal, rendering providers who are part of a group practice are now required to be digitally linked to any service location where they bill Medicaid patients for that group. Any charges billed for a provider at a location where she is not linked will be denied.
However, so many providers are receiving these denials that IHCP is now changing the transaction to “post-and-pay” status. That means that while the EOB 1010 message will still be transmitted in the remittance advices (RAs), payments will be issued. But only through August 31, 2017. Effective September 1, 2017, EOB 1010 will revert to a denial status.
What Should You Do?
- Review RAs in detail to locate any EOB 1010 messages.
- Update all service location profiles with the providers in question, and be sure the effective and end dates are accurate. (This training webinar, “Provider Healthcare Portal: Online Enrollment”, should help, along with the specific instructions listed in IHCP Banner Page BR201719.)
- Resubmit any claims that have been denied.
For more information, visit Indiana Medicaid’s News Summary webpage and watch for updates.
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