MedicaidPrior AuthMedium impact
BT202565: IHCP clarifies hospice prior authorizations, billing and reimbursement
Indiana Medicaid (IHCP)·IN · Palliative Care·Claims & Billing
Effective date
May 22, 2025
We identified it
Jun 18, 2026
Summary
IHCP (Indiana Health Coverage Programs) has clarified hospice prior authorization requirements, billing procedures, and reimbursement rules. Hospice providers must follow specific PA processes for different member types and use designated revenue codes for billing, with special requirements for nursing facility room-and-board payments.
Action Required
Immediately: Hospice billing teams must ensure compliance with IHCP hospice PA processes by following MCE requirements for HIP, Hoosier Care Connect, and PathWays members, or Traditional Medicaid processes for FFS members. Update billing systems to use correct revenue codes (183, 185, 193, 199, 551, 561, 650, 651, 652, 655, 656, 657, 658, 659) based on service type and member eligibility. For nursing facility hospice members, ensure Medicaid Hospice Election forms include nursing facility name and Medicaid Provider Number to prevent payment issues. Submit room-and-board claims for dually eligible members directly to Gainwell or MCE as they do not cross over from Medicare.