As we wrap up 2018, the Indiana Health Coverage Programs (IHCP) has released a variety of information Indiana healthcare providers need to know about billing Medicaid in 2019. We’ve created a short list of the top five things you should know.
Revised NPI Reporting Requirements for Enrolling Providers
Effective January 1, 2019, IHCP will revise its National Provider Identifier (NPI) reporting requirements for healthcare providers enrolling with IHCP. Healthcare providers must enroll using the type of NPI that aligns with the organizational structure under which the provider will be doing business with the IHCP, per their IHCP enrollment application. Generally, the following will be required:
- An individual healthcare practitioner who is enrolling with the IHCP to render services but who will not be billing the IHCP directly for his or her services must enroll with the IHCP using his or her Type 1 NPI.
- An individual healthcare practitioner who is enrolling to bill the IHCP directly for his or her services and is conducting business with the IHCP as an individual or sole proprietor (including a single-member LLC electing to do business as an individual, referred to as a disregarded entity), must enroll using his or her Type 1 NPI.
- An individual healthcare practitioner who is enrolling to bill for his or her services and who is conducting business with the IHCP as a business entity (C Corporation, S Corporation, Partnership, or an LLC (including a single member LLC electing to do business as a corporation) must enroll the business using the business entity’s Type 2 NPI and themselves using their personal Type 1 NPI.
- An organization that is enrolling to bill for services and that is conducting business with the IHCP, as a business entity including a C Corporation, S Corporation, LLC, Partnership, and Trust/Estate, must enroll using the business entity’s Type 2 NPI.
For more information about the new NPI Reporting Requirements, check out IHCP Bulletin BT201863.
New Enrollment Fee
Also beginning January 1, 2019, IHCP providers subject to the enrollment application fee will be required to pay $586 with initial enrollments, including changes of ownership and enrollment revalidations. Applications submitted online or postmarked before January 1, 2019, will be accepted with a fee payment of $569. Applications submitted online or with a postmark of January 1, 2019, or later must pay $586.
To see which providers are subject to the enrollment application fee, review the IHCP Provider Enrollment Risk Category and Application Fee Matrix.
New Timely Filing Limits
As we previously reported, IHCP will revise the timely filing limit on claims for services rendered through the fee-for-service delivery system to 180 calendar days from the date of service
(DOS). The 180-day timely filing limit will apply to claims with DOS on or after January 1, 2019. For inpatient claims, the 180-day limit will be based on the member’s date of discharge. The current 1-year timely filing limit will continue to apply to claims with DOS or dates of discharge on or before December 31, 2018.
Learn more about managing timely filing limits by reading our recent article, “Stay Up-to-Date on Timely Filing Limits at Every Point in the Revenue Cycle,” and be sure to download our Timely Filing Limits Cheat Sheet while you’re there.
New Presumptive Eligibility Guidelines
Look for changes to presumptive eligibility coverage in January as well. Individuals determined presumptively eligible for IHCP under the Presumptive Eligibility – Adult (PE Adult) benefit plan will be served through the fee-for-service delivery system rather than through managed care. As a result, PE Adult applications with effective dates on or after January 1, 2019, will not require a managed care entity (MCE) selection.
Since the changes are not effective until January 1, PE Adult applications with effective dates before January 1, 2019, will continue to require an MCE selection. In addition, PE Adult members enrolled with the IHCP before January 1, 2019, will receive services through the MCE they were initially enrolled with for the duration of their presumptive eligibility period.
Changes to IHCP Website
Finally, IHCP is migrating its provider website from the current indianamedicaid.com domain to the State’s in.gov domain. Phase 1 of the migration is complete and users who go to indianamedicaid.com are now redirected to in.gov/medicaid/. As well, IHCP will redirect the URL addresses for various indianamedicaid.com pages and articles to the new URL addresses in the in.gov domain. In most cases, there will be a straight “old page”-to-“new page” redirect; however, in some cases, due to the new layout, the redirect will be from an “old page” to a “related new page.”
In Phase 2 of the website project, IHCP will migrate the provider applications that are currently still hosted at indianamedicaid.com. Because these applications are connected to content pages that have already been migrated, users may be redirected between the two domains for various functions until the migration is complete. Users also can continue to use the normal navigation tools (such as the arrow key) to toggle between the two domains.
For more information about IHCP’s website migration, review the IHCP Bulletin BT201858.
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