Materials order form provider manuals and quick reference guides ambetter from mhs claimsbilling indiana medicaid bulletins and faqs medicaid. View the most recent published manual at the link below. Policy changes that have occurred since the effective date noted are announced in ihcp provider bulletins and banner pages. Please refer to the plan contract often referred to as the evidence of coverage for the services. The medical policy manual has been developed to ensure the success of the ihcp. The medical policy manual has been developed to ensure the success of the indiana health. Indiana family and social services administration regional telehealth resource center. The following list reflects examples of conduct for which provider enrollments may be terminated and meets the definition of for cause as defined by cms. Medical policy statements prepared by caresource and its affiliates do not ensure an authorization or payment of services. Sep 24, 2020 the mdwise provider manuals inform you about our health plans, guidelines, requirements, policies and procedures, as well as help to answer everyday questions you may have. The requirements for state burial assistance under the medicaid program are also. Follow all mdwise policies and procedures and federal and state requirements.
Learn more about the appeal process on the fssa members appeals page here and in the indiana health coverage program policy manual here. This manual is intended to support all entities and individuals that have contracted with anthem. Indiana office of medicaid policy and planning burns health. Facility and professional reimbursement policies medical policies and um guidelines joining anthem networks network update a periodic newsletter publication designed to educate physicians, facilities and hospitals and their appropriate staff on administrative issues. Med works offers the same coverage levels as regular medicaid. The requirements for state burial assistance under the medicaid program are also included.
The indiana health coverage programs ihcp offers coverage for inpatient and outpatient. Find information for assessing coverage options, guidelines for clinical utilization management, practice policies and support for delivering benefits to our. Indiana family and social services administration, office of medicaid policy and planning. The manual contains eligibility and administrative policies based on state and federal laws and regulations that govern the programs, as well as. Jan 01, 2021 indiana medicaid policy name policy number date effective metabolic and bariatric surgery for 18 years of age and older mm0257 01012021 policy type medical administrative pharmacy reimbursement medical policy statement prepared by csmg co. Jan 01, 2021 medical policy statements, provider manuals, member handbooks, andor other policies and procedures. Federal regulation requires states to provide notice when the enrollment of a medicaid enrolled provider has been terminated for cause.
Read online medical policy manual indiana medicaid provider home provider manual health insurance plans in indiana other policies e. Introduction to ihcp claim submission and processing note. Eds managed care unit indiana health coverage programs care management organizations policies and procedures manual library reference number. This manual will be used as a reference handbook for the family and social services administrations fssa office of medicaid policy and planning ompp, health care excel hce, and other state contractors and partners. Medicaid will reimburse for certain services when the provider and patient locations are 20 miles apart. Mar, 2017 indiana health coverage program policy manual. Hcbs programs allow members to live in a community setting and avoid institutional placement. The medical policy manual has been developed to ensure the success of the indiana health coverage programs ihcp.
Hoosier healthwise is a health plan for children, pregnant women and lowincome families. To be eligible for any hcbs program, you must meet medicaid guidelines and hcbs programspecific eligibility guidelines. Jan 01, 2021 provider manuals, member handbooks, andor other policies and procedures. Benefit determinations are based on the specific facts. If you have any questions regarding these policies, please contact member services and ask to be directed to the medical management department. Final medicare hospice rules effective january 23, 2006 and medicaid hospice authorization changes overview this bulletin summarizes the final medicare hospice rules that became effective january 23, 2006. Medicaid requires that the originating site must obtain and maintain patient consent. Mhs provider manual pdf, updated november 30, 2020 indiana medicaid provider manual pdf mhs provider quick reference guide pdf, updated november 30, 2020 mhs dental provider manual pdf. Each medicaid eligible patient admitted to an acute psychiatric facility or unit must have an individually developed plan of care poc. To access the published versions of the medical policy manual, go to the new provider reference materials page on this site. Medicaid billing guidebook updated december 2017 the guidebook is a highlevel overview of medicaid claiming for schoolbased health services and related administrative activities in indiana.
Family and social services administration office of. Office of medicaid policy and planning instructions for the. Jan 01, 2021 medical policy statement indiana medicaid policy name policy number effective date metabolic and bariatric surgery for policy type medical administrative pharmacy reimbursement medical policy statements prepared by csmg co. Medicaid eligibility policy manual the indiana health coverage program policy manual is an integrated eligibility manual that contains information about health coverage under medicaid, hoosier healthwise, hoosier care connect, and the healthy indiana plan. This manual will be used as a reference handbook for the family and social services administration fssa office of medicaid policy and planning ompp and other state contractors and partners. Indiana health coverage programs provider bulletin bt200607 march 9, 2006 to. Healthy indiana plan hip hoosier healthwise hhw, including children in the childrens health insurance program chip hoosier care connect. Under feeforservice reimbursement, medicaid providers, including school corporations, bill claims directly to medicaid s claims processing contractor. Medical policy manual indiana medicaid provider home. For help with a medicaid application, or for any further questions about the medicaid program, contact the indiana family and social services administration.
For members between 22 and 65 years old in a psychiatric hospital of 16 beds or fewer, or a person 65 years old or older, a poc must be developed by the attending or staff physician. Med works is medicaid for employees with disabilities. The manual is not intended to be a complete statement of all anthem policies or procedures. Dec 20, 2017 as defined in the indiana health coverage programs provider manual, is a medicaid service delivery system that reimburses providers on a per service basis. The information in this module applies to indiana health coverage programs ihcp claim submission and processing for services delivered through the feeforservice ffs delivery system, with the following exceptions. The indiana health coverage program policy manual is an integrated eligibility manual that contains information about health coverage under medicaid. Mhs provider manual pdf, updated november 30, 2020 indiana medicaid provider manual pdf mhs provider quick reference guide pdf, updated november 30, 2020.
Medicaid provider home 710b3f a92d7332ac395517459e4d60cd. Cms also contracts allwell to provide part d prescription medications to members enrolled in certain health plans which include a part d benefit. Please refer to the plan contract often referred to as the evidence of coverage for the services referenced in the medical policy statement. The indiana health coverage programs ihcp medical policy manual contains information about indiana medicaid policies. If you have any questions about these policies, call mdwise provider relations staff or mdwise customer service. Center for connected health policy 1 indiana medicaid program. The indiana family and social services administrations site for medicaid applications. Allwell is a licensed health maintenance organization hmo contracted with the centers for medicare and medicaid services cms to provide medical and behavioral health services to dualeligible members. Eligibility indiana family and social services administration, medicaid policy indiana health coverage program policy manual. Monthly checklist of state publicationsnew serial titlesthe. Provider and billing manual indiana health insurance plans. State of indiana office of medicaid policy and planning instructions for the home health agencies medicaid cost reporting form general instructions applicable for cost report revision october 1, 2014 required for fiscal year ends october 31, 2014 and after. The indiana health coverage program policy manual is an integrated eligibility manual that contains information about health coverage under medicaid, hoosier healthwise, hoosier care connect, and the healthy indiana plan.
Products covered by indiana medicaid include, but are not limited to, the following. Indiana offers eight medicaid home and communitybased services programs that target specific groups. This manual does not contain legal, tax or medical advice. Indiana health coverage program policy manual chapter. Office of medicaid policy and planning instructions for. Indiana family and social services administration, medicaid. Many disabled people feel that they may be able to return to work, but are fearful of losing their medicaid benefits. The use of provider within this manual refers to entities and individuals contracted with anthem that bill on a cms 1500. Indiana mac time study participant manual updated july 2016.
Here you will find information for assessing coverage options, guidelines for clinical utilization management, practice policies, the provider manual and support for delivering benefits to our members. Anthem blue cross and blue shield indiana medicaid. Medical policy manual indiana medicaid ihcp providers. Med works is a program designed to allow disabled employees to work without fear of losing their medicaid. Family and social services administration office of medicaid. Policies and procedures as of july 1, 2020 version. Indiana health coverage program policy manual ihcppm the indiana caseworker manual for medicaid applications. You are encouraged to establish new bookmarks for this page if you access the manual frequently. Mdwise policies are described in this provider manual.
The formulation of ihcp medical policies will involve an array of individuals and a complex set of tasks for each policy. Other policies and procedures not included in this manual may be posted on our website or published in specially targeted communications, including but not limited to bulletins and newsletters. The indiana health coverage program policy manual ihcppm is an integrated eligibility manual that contains information about health coverage under medicaid, hoosier healthwise, hoosier care connect, and the healthy indiana plan. Feb 22, 2021 a onepage overview of schoolbased medicaid administrative claiming. The indiana health coverage program policy manual ihcppm sets out the requirements for medicaid eligibility in indiana. Policies are considered guidelines and are not intended to infer benefits or coverage for a specific member. Fqhcs, rural health clinics, cmhcs, and critical access hospitals are exempt from this requirement. May 28, 2019 medical policy statements, provider manuals, member handbooks, andor other policies and procedures. Anthem blue cross and blue shield indiana medicaid provider.
609 1564 414 796 365 1277 511 531 262 1411 722 1040 1583 1006 838 1362 863 364 1596 551 1498 1557 1428 118 1138 923 1549 166 1154 948