How To Become A Medicaid Provider In Indiana

What Are Medicaid Waivers

Indiana Medicaid expansion

In the early stages of the Medicaid program people, when families were unable to cover the cost of caring for individuals with disabilities the people with disabilities were often sent to live in long-term care facilities. Medicaid would cover the cost of a person living in one of these facility but would not, at that point in time, cover the cost of services provided to individuals outside of these facilities.

Under the idea that many people with disabilities could live and thrive in the community, the Medicaid waiver program was started in 1981 to allow these people to avoid institutionalization while still being able to receive the services they need. These waivers, known as Home and Community-Based Services Waivers focus on providing services to individuals living in the community.

The Arc of Indiana created an Introduction to Indianas Medicaid Waiver Program for Home and Community Based Services Guide . This document includes a description of the waiver programs in Indiana with contact information for relevant agencies in the state. It also has a section on Charting the LifeCourse, a tool that helps create a plan for a good life.

For people with intellectual and/or developmental disabilities, there are two waivers managed by the Bureau of Developmental Disabilities Service : the Family Supports Waiver and the Community Integration and Habilitation Waiver.

Asthma And Copd Support

We can help you control your asthma or COPD.

If you need help getting the services or supplies you need, contact your Member Services Advocate. We can assist with the process of getting supplies or medications, make an appointment with your doctor, or connect you with a care manager for personal support.

What Are The Different Types Of Medicaid

When you apply for Medicaid, information about you and your family is collected. Theres quite a bit of information required to complete the Medicaid process, so be prepared to gather and provide documentation in order to complete the process. In fact, you can apply for Medicaid with only a few pieces of information and the system will mail you a list of everything else you need to provide.

Once you apply for benefits and provide all the requested information, your eligibility will be determined by the states computer system. It will look at everything youve provided and figure out if youre eligible for Medicaid and, if you are eligible, which category of Medicaid youll receive.

The system is set up to find the best benefits for you, in the event that youre eligible for multiple categories of Medicaid. In the next section , you can learn about the different categories of Medicaid.

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Private Practice And Insurance Credentialing

Those establishing a private practice are often confused about insurance credentialing and procedures for billing third-party networks for their services.

The first step in setting up your revenue cycle is applying for credentialing and obtaining participating provider contracts with your chosen insurance companies. While this can be complicated, Bikham Healthcare takes on this cumbersome process on your behalf. We provide you with guidance and industry know-how so that you can set up the revenue cycle for your new practice with ease.

Use The Ihcp Provider Healthcare Portal To Submit Enrollment Transactions

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Providers are encouraged to use the IHCP Provider Healthcare Portal to apply and maintain their enrollment profiles as IHCP providers. Providers will find the online process much quicker and easier than using paper forms. Online help guides users through the process from start to finish and provides immediate confirmation of enrollment transaction submissions.

The Portal’s online provider enrollment feature is an easy-to-use option for providers enrolling for the first time, as well as for current providers who need to enroll a new service location, report a change in ownership, or revalidate their enrollment. The online enrollment process includes helpful features and numerous advantages over the current paper process:

Online transactions are more efficient and convenient.
Business and personal information is more secure.
Systematic checks verify that information is complete, reducing inadvertent submission errors and the need for corrections.

Enrollment applications can be easily saved and edited as needed during the process.
Supporting enrollment documentation can be uploaded electronically and submitted with the transaction.
Providers can monitor the status of submitted transactions in real time.

Web-based training for using the Portal to enroll is available on the page on this site. Assistance is also available from . Providers not using the Portal may use paper enrollment transaction forms.

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Lead Screening In Children

Lead poisoning is dangerous. If it is not treated in small children, it can cause long term problems. Lead can be found in:

A special blood test is ordered by your doctor to check for lead poisoning. The test is usually given between the ages of 6 months and 2 years. If your child has not been tested, your doctor might want to test up to the age of 6 years. More testing may be necessary if your child has tested positive for lead. For more information, contact your Member Services Advocate. You can also talk to your childs doctor at their next well visit.

Welcome To Indiana Medicaid

Welcome to Indiana Medicaid. On this site, you can learn about the different Medicaid programs and how to apply. Check out our Eligibility Guide to learn about eligibility for certain programs and see if you may qualify.

If you use assistive technology and the format of any material on this website interferes with your ability to access information, please . If you have a complaint about web accessibility or print communications in accessible formats, you may also . To enable us to respond in a manner most helpful to you, please indicate the nature of your accessibility issue, the preferred format in which to receive the material, the web address of the requested material, and your contact information.

Unitedhealthcare Connected General Benefit Disclaimer

This is not a complete list. The benefit information is a brief summary, not a complete description of benefits. For more information contact the plan or read the Member Handbook. Limitations, copays and restrictions may apply. For more information, call UnitedHealthcare Connected® Member Services or read the UnitedHealthcare Connected® Member Handbook. Benefits, List of Covered Drugs, pharmacy and provider networks and/or copayments may change from time to time throughout the year and on January 1 of each year.

You can get this document for free in other formats, such as large print, braille, or audio. Call Member Services, 8 a.m. – 8 p.m., local time, Monday – Friday . The call is free.

You can call Member Services and ask us to make a note in our system that you would like materials in Spanish, large print, braille, or audio now and in the future.

Language Line is available for all in-network providers.

Puede obtener este documento de forma gratuita en otros formatos, como letra de imprenta grande, braille o audio. Llame al Servicios para los miembros, de 08:00 a. m. a 08:00 p. m., hora local, de lunes a viernes correo de voz disponible las 24 horas del día,/los 7 días de la semana). La llamada es gratuita.

Puede llamar a Servicios para Miembros y pedirnos que registremos en nuestro sistema que le gustaría recibir documentos en español, en letra de imprenta grande, braille o audio, ahora y en el futuro.

Get The Health Care You Deserve

Medicare Provider Enrollment Through PECOS

Hoosier Care Connect is a program that serves members who are aged, blind or disabled, including foster children and wards of the State.

This plan is available in all Indiana counties.

To see if you qualify, you can:

Visit the State of Indianas website at in.gov/Medicaid/members
Visit a local FSSA office. A list of office locations can be found here:

We can also assist with interpreter services, including American Sign Language. To ask for help, please call , TTY 711, Monday through Friday, 8 am to 8 pm EST.

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How To Become A Provider With Cicoa

All agencies interested in providing services through CICOA must first be certified through the Medicaid Waiver program, administered through the Indiana Division of Aging.

This differs from traditional Medicaid certification. Please contact the FSSA Waiver Provider Specialist at 317-232-4650 or visit the FSSA website for information.

CHOICE/Title III/SSBG Providers

The majority of CICOA’s business partners become providers of service through the Medicaid Waiver and CHOICE programs with an open-ended contract, which means there is no guarantee of referrals for service to the agency or dollar volume that may be purchased. Clients are given a pick list of providers to choose from based on the service needed.

CICOA has a two-year contract period for providers. Current contracts run July 1, 2021 through June 30, 2023. New contracts can be initiated at any time during the contract period, but will expire June 30, 2023. All providers need to submit new contracts for the contract period that begins July 1, 2021.

Current providers can submit updated contact information via the Provider Profile form at any time.

Provider Contracts Application Process

1

All agencies interested in providing services for CICOA and our clients must be certified through the Medicaid Waiver program. The Medicaid Waiver program is administered through the Indiana Division of Aging and differs from traditional Medicaid certification. Please contact the FSSA Waiver Provider Specialist at 317-232-4650 or , or visit their website for information on this process.

2

All providers must also be licensed through the Indiana State Department of Health.

!

Please do not contact CICOA for provider information until the above steps have been completed.

3

Submit an application to CICOA to provide CHOICE, SSBG and Title III services. Please read the Application Process for full details.

Provider Profile

Additional Documents Needed

Certificate of Insurance for general aggregate liability coverage of at least $1,000,000, with CICOA listed as additional insured
Certificate of Insurance for workers compensation insurance, with CICOA listed as certificate holder

Current license, if applicable
Medicaid Waiver provider certification letter, if applicable

4

Providers should be aware that the establishment of a contractual agreement provides no guarantee of referrals for service to the agency.

How To Become A Medicaid Provider

Providers delivering autism spectrum disorder services must be enrolled with SCDHHS as a Medicaid provider to deliver and bill for Medicaid state plan benefit ASD services.

To enroll with SCDHHS as a Medicaid provider:

Prep for Enrollment: Providers will need a national provider identification and taxonomy number. Apply for individual National Provider Identifier number. Use the correct taxonomy code as listed in the provider manual.

Complete and submit the Medicaid provider enrollment application.

SCDHHS will notify providers of successful enrollment.

*Note, BCBA and BCaBA providers must enroll individually. If there is a group practice, a group enrollment must also be completed.

To enroll with one of the managed care organizations , a provider must be an approved Medicaid provider. Providers need to contact the MCO directly to complete the network enrollment process. Providers are not required to enroll with a MCO, but they may not be reimbursed by the MCO for services provided to beneficiaries enrolled in managed care.

To enroll with a MCO:

Contact each MCO to begin the process of contracting, credentialing and enrolling.
MCO contact information:
Healthy Blue 757-8286

First Choice by Select Health 741-6605

Molina Health Care of South Carolina 237-6178

P. O. Box 8206 Columbia, SC 29202-8206 | Email: | phone: 549-0820

Language Services

If your primary language is not English, language assistance services are available to you, free of charge. Call: 1-888-549-0820 .

Initiating Your Enrollment Transaction

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The following steps outline the basic enrollment process for this provider type. More detailed information is available in the provider reference module.

Before submitting an Indiana Health Coverage Programs enrollment application, waiver providers must have Family and Social Services Administration certification. Waiver specialties are assigned during the certification process. For more information, see the following provider reference modules, available on this website:

Refer to the for a list of the documentation required for IHCP enrollment or revalidation under each applicable provider specialty.

See the to determine your risk level and whether you are required to pay an application fee. The enrollment or revalidation screening process is determined by the risk level that applies to your provider type. At its discretion, the State may assign a provider a higher risk level that supersedes the risk level assigned by the Centers for Medicare & Medicaid Services and noted on the matrix.

Check the for the specialties and subspecialties affected.

Some waiver specialties and subspecialties require the payment of application fees during enrollment, revalidation, or change of ownership for each service location. Submit confirmation of your electronic payment of the fee to the IHCP or document in your enrollment submission that you have paid the fee to Medicare or another state Medicaid program.

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Can Children Be Eligible For Medicaid And Medicaid Waivers If The Parents Arent Low

When a child, whos under 18 years old, with a disability applies for Medicaid that childs income may be the only income used for the determination. Since most children dont have income theyll be able to pass the financial tests for Medicaid.

This is explained further in the Indiana Medicaid Policy Manual :

2035.20.00 HOME AND COMMUNITY-BASED SERVICE WAIVERS

Parental income and resources are not considered when determining the Medicaid eligibility of individuals less than 18 years of age who are being considered for Home and Community-Based Services . Parents should be asked early in the interview if they want retroactive Medicaid coverage for the child. If retroactive coverage prior to the waiver effective date is requested, the parents must provide verification of their income and resources. Generally most parents do not want retroactive coverage for the child prior to the waiver and are resistant about being asked any questions about themselves. If the parents do not want the retroactive coverage, they are not required to provide information about their own finances for those retroactive months.

As each screen is completed, the questions will relate to the situation of the child only, if retroactive coverage is not desired.

Unitedhealthcare Senior Care Options Plan

UnitedHealthcare SCO is a Coordinated Care plan with a Medicare contract and a contract with the Commonwealth of Massachusetts Medicaid program. Enrollment in the plan depends on the plans contract renewal with Medicare. This plan is a voluntary program that is available to anyone 65 and older who qualifies for MassHealth Standard and Original Medicare. If you have MassHealth Standard, but you do not qualify for Original Medicare, you may still be eligible to enroll in our MassHealth Senior Care Option plan and receive all of your MassHealth benefits through our SCO program.

Community Integration And Habilitation Medicaid Waiver

The Community Integration and Habilitation waiver is to be used as a “needs based” waiver ONLY for people who meet specific criteria. To move from the Family Supports waiver onto the CIH waiver, an individual must meet specific eligibility/priority criteria which may include:

Death of primary caregiver and no other caregiver available Caregiver over 80 years of age and no other caregiver available Evidence of abuse or neglect in the current placement Extraordinary health and safety risk Eligible individuals transitioning to the community from a nursing facility, extensive support needs homes or state operated facilities Eligible individuals determined to no longer need active treatment in a group home Eligible individuals transitioning from 100% state funded services Eligible individuals aging out of Department of Education, Department of Child Services or supported group living and Eligible individuals requesting to leave a Large Private Intermediate Care Facility for Individuals with Intellectual Disabilities .

In addition to the same services approved for the FS waiver , the CIH waiver allows for a larger budget for eligible services and may provide the following additional approved services : Community Transition Rent and Food for Unrelated Live-In Caregiver Residential Habilitation and Support

How Providers Enroll With The Ihcp

Indiana Medicaid recipients now have to work for benefits

The page offers information about the current provider enrollment process, including links to a number of web pages with detailed information helpful to providers interested in serving IHCP members.

The IHCP enrollment webinar, Ways to avoid common mistakes during the enrollment process, is another resource and covers important details for enrolling as an IHCP provider.

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Indianas Medicaid Waiver Programs: Home And Community

Marci Wheeler, MSW

Indianas Medicaid Home and Community-Based Services Waiver program provides individualized supports to assist people, of all ages, to live successfully in home and community settings. In the past, Medicaid only paid for long-term care services in an institutional setting, such as nursing facilities and group homes. The waiver program “waives” the necessity of admission into an institution in order for Medicaid to pay for needed home and community-based services.Waivers fund therapeutic and other needed supports and services. HCBS Medicaid waivers make Medicaid funds available as an alternative to institutional care if supporting the individual, in the home and/or a community setting is no more than the cost of care within an institutional setting.

Currently there are five statewide Medicaid waiver options for an individual in Indiana. One of those Waivers, however, is closed and no longer accepting new applicants. The Psychiatric Residential Treatment Facility Transition waiver is for children and youth with serious emotional disturbances or serious mental illness who transitioned from the prior Community Alternative to the PRTF Grant. As of October 1, 2012, no additional children can apply for or receive waiver services through the PRTF Transition waiver. The other four Medicaid waiver programs are accepting applications and new individuals.

1. Meet Medicaid eligibility requirements.