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BT202370: IHCP releases frequently asked questions regarding NEMT carve-out changes
Indiana Medicaid (IHCP)·IN · Emergency Medicine·Provider Bulletin
Effective date
Jul 1, 2023
We identified it
Jun 19, 2026
Summary
Indiana Medicaid has clarified NEMT carve-out changes affecting ambulance billing. Ambulance providers must bill different entities based on transport type: IHCP for ALS/BLS services, Verida for non-ALS/BLS services (except nursing facility residents), and nursing facilities for their residents' non-ALS/BLS transport.
Action Required
Immediately: Billing team must update workflows to route ambulance claims correctly - bill IHCP (Gainwell) for all ALS/BLS services, bill Verida using CMS-1500 with 'non-ALS/BLS Trip' in field 23 for non-ALS/BLS services, and bill nursing facilities directly for their residents' non-ALS/BLS transport. Update billing system rules to require U1/U2 modifiers for ground mileage separation. Train staff on medical necessity screening to avoid recoupment.