As we wrap up 2019, the Indiana Health Coverage Programs (IHCP) has released a variety of information Indiana healthcare providers need to know about billing Medicaid in 2020. We’ve created a short list of the top five things you should know.
New Enrollment Fee
Beginning January 1, 2020, IHCP providers subject to the enrollment application fee will be required to pay $595 with initial enrollments, including changes of ownership and enrollment revalidations. Applications submitted online or postmarked before January 1, 2020, will be accepted with a fee payment of $586. Applications submitted online or with a postmark of January 1, 2020, or later must pay $595.
To see which providers are subject to the enrollment application fee, review the IHCP Provider Enrollment Risk Category and Application Fee Matrix.
Package B Expands Benefits for Qualified Immigrants
IHCP has expanded benefits for certain qualified immigrants identified as a permanent residents. This new benefit package, titled Package B – Emergency Services Only Coverage with Pregnancy Coverage. Package B, will cover prenatal and postpartum services, in addition to the emergency services offered through Package E – Emergency Services Only. Package B services will be delivered on a fee-for-service (FFS) basis.
To qualify for Package B services, a member must have the following:
- Immigration status equal to “Lawful Permanent Resident”
- Eligibility for Package E
- Be pregnant or within the 60-day postpartum period
When billing for Package B members, providers must either indicate that the service rendered meets the definition of an emergency service as defined in the Emergency Services provider reference module or include a diagnosis code that indicates the service was related to prenatal or postpartum treatment.
Though technically this new coverage has been offered since November 30, 2019, we’re adding it to our 2020 list because it’s just getting off the ground. For more information about Package B, check out the IHCP Bulletin BT201963.
Copayments Implemented for Adult PE Plans
Also from late in 2019, copayments have been implemented for members enrolled in the Presumptive Eligibility Adult (PE Adult) FFS benefit plan.
Because the covered services of the PE Adult benefit plan mirror those available under the Healthy Indiana Plan (HIP) Basic benefit plan, beginning with dates of service on or after November 27, 2019, the PE Adult benefit plan will also include applicable copayments and copayment exclusions like those in the HIP Basic plan. The copayment requirements are listed below.
| Claim Type | Copayment | Methodology | Exclusions |
| Medical Claims | $4.00 | Per rendering provider date of service and claim | Claim details with an emergency indicator |
| Outpatient Claims | $4.00 | Per date of service when revenue codes are nonemergency | Emergency Diagnosis Codes |
| Outpatient Claims | $8.00 | Per date of service, when code billed on claim is 450-459 | Emergency Diagnosis Codes |
| Inpatient Claims | $75.00 | Per admission | Admission Types of 1 and 5 and transfers with an admission source of 4 |
| Preferred Drugs | $4.00 | All preferred: generics, multisource brands, single-source brands, over the counter (OTC)/pharmacy supplements, compounds | None |
| Nonpreferred Drugs | $8.00 | All nonprefered: generics, multisource brand agents, OTC drugs | None |
The following additional exclusions from copayments also apply for PE Adult members:
- Family planning services
- Preventative care services
- American Indians/Alaska Natives
Check out IHCP Bulletin BT201961 for more details about the new copayments.
IHCP Removes Therapy Visit Limit for Package C Members
IHCP also is removing the 50-visit limit per rolling 12 months for physical, speech, occupational, and respiratory therapy for Package C – Children’s Health Insurance Program (CHIP) members. This change, effective for dates of service on or after January 17, 2020, is part of the IHCP federal compliance report with the Centers for Medicare & Medicaid Services (CMS) for the Mental Health Parity and Addiction Equity Act (MHPAEA). IHCP Bulletin BT201971 has more details.
New Mailing Address for FFS Prior Authorization
Finally, as of November 1, 2019, DXC Technology assumed responsibility for all fee-for-service (FFS) prior authorization (PA) and utilization management (UM) services. Previously, those were administered by Cooperative Managed Care Services (CMCS).
As a result, DXC Technology has established a new mailing address for providers when submitting PA requests and/or submitting additional or supporting documentation: Prior Authorization – FFS Medical DXC Technology, P.O. Box 7256, Indianapolis, IN 46207-7256.
The new address is already effective, but as of Monday, December 30, 2019, any mailed documentation mailed to the previous address may be returned to the provider by the U.S. Postal Service. See IHCP Bulletin BT201968 for more information.
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