IHCP clarifies coverage for Hoosier Healthwise members during retroactive eligibility period
As part of a collaborative workflow improvement project with stakeholders, the Indiana Health Coverage Programs
(IHCP) is issuing a clarification to IHCP Banner Page BR201839. Members determined as retroactively eligible under
Hoosier Healthwise aid categories do not receive a managed care assignment for the retroactive eligibility period.
Instead, during the retroactive period, member benefits are covered through the fee-for-service (FFS) delivery system.
However, the exception to this policy is for newborns whose mothers were enrolled with a managed care assignment on the date of the child’s birth. In this case, the baby is assigned to the mother’s managed care entity (MCE), retroactively effective to the date of birth. The mother’s and the baby’s coverage remains with the MCE during the baby’s retroactive period. Once a Member ID is assigned to the baby, providers may send claims for the baby’s care to the mother’s MCE. Prior authorization (PA) for services may be required.
Providers should check with the MCE about PA before submitting claims, or retroactive PA requests. For more information about Hoosier Healthwise, see the Member Eligibility and Benefit Coverage provider reference module at in.gov/medicaid/providers.
Instead, during the retroactive period, member benefits are covered through the fee-for-service (FFS) delivery system.
However, the exception to this policy is for newborns whose mothers were enrolled with a managed care assignment on the date of the child’s birth. In this case, the baby is assigned to the mother’s managed care entity (MCE), retroactively effective to the date of birth. The mother’s and the baby’s coverage remains with the MCE during the baby’s retroactive period. Once a Member ID is assigned to the baby, providers may send claims for the baby’s care to the mother’s MCE. Prior authorization (PA) for services may be required.
Providers should check with the MCE about PA before submitting claims, or retroactive PA requests. For more information about Hoosier Healthwise, see the Member Eligibility and Benefit Coverage provider reference module at in.gov/medicaid/providers.
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