See the Vision Care Policy
The CSHCS Program provides basic dental coverage for all clients. The dentist must be a provider for the CSHCS Program. Call your Prior Authorization nurse to have the participant linked to the dentist’s office before the first visit.
The CSHCS Program covers the Primary Care Physician’s office visits when the office is a provider for CSHCS. Most procedures done in the office, such as immunizations, are also covered.
Yes, but not if the family has Medicaid. We pay $0.245 cents per mile for trips over 49 miles one-way. The person requesting reimbursement must fill out W-9 and Direct Deposit forms. Please contact us at 1-317-233-1351 or 1-800-475-1355, option 4 for Travel Reimbursement information.
We do not charge a copay for our services. The CSHCS Program reimburses at Medicaid rates for fees and services that we provide under the program, but we do not mirror the billing of Medicaid. The CSHCS Program will pay the Medicaid allowed rate, the allowable amount minus any payment by primary insurance, or the copay amount, whichever is the lesser of the three.
Participants age off the program the day before they turn 21 years of age. Participants who have cystic fibrosis can remain on the program indefinitely as long as they meet financial / program requirements.
State Legislation, 410 IAC 3.2
A Re-Evaluation Packet (State Form 50803) will be mailed to each participant annually. This will normally be within the 2nd month prior to the anniversary month of the participant within the CSHCS Program. If the participant or their parent/guardian fails to provide the required information within the allotted time, the participant’s eligibility will cease, and their case will be closed.
Once CSHCS receives a completed Re-Evaluation Packet, we will do a determination of financial and medical eligibility for continued participation in the program, the result of which will be communicated to the participant or their parent/guardian via a written notice.
The participant will be advised in writing of the right to re-apply or appeal our decision in accordance with the Administrative Orders and Procedures Act (IC 4-21.5 et seq.).
Contact the CSHCS Claims Section at 1-317-233-1351 or 1-800-475-1355 option 5 and state that you are being billed and you need a collections letter. We will mail you out a collections letter; follow the steps within the letter.
The medical provider will obtain a PA before a client presents to the office. Medical providers can be ‘linked’ to a client and a PA will not be needed for each office visit. A PA is needed for diabetic supplies, durable medical equipment, therapies, supplies, surgeries, ER visits, observation stays, hospitalizations, and orthodontia.
Contact a PA Nurse.
The CSHCS Program cannot accept the IEP from the school. Participants must provide the Physician Health Summary form from the participant’s doctor.
The parent or participant should present the CSHCS card at all medical visits, therapy visits, and at the pharmacy. Medical visits include the emergency room, hospital admission, outpatient surgery center, and the doctor’s office. The provider must be a provider for the CSHCS Program or we cannot reimburse the provider. The provider can call the Provider Relations unit with their NPI number to check on their provider status at 1-317-233-1351 or 1-800-475-1355, option 5.
It is the provider’s responsibility to obtain a PA. The PA forms are online or can be obtained by fax from the PA unit by calling 1-800-475-1355, option 3.
The medical provider will obtain a PA before a client presents to the office. Medical providers can be ‘linked’ to a client and a PA will not be needed for each visit. A PA is needed for diabetic supplies, durable medical equipment, therapies, supplies, surgeries, ER visits, observation stays, hospitalizations, and orthodontia.
Care Coordination is a process to try to bridge the gaps in patients' care as they move through the healthcare system. It's about making sure that patients' needs are assessed and that someone is trying to help meet those needs. These are not just medical needs, but also social needs for how the family and patient can cope with their medical condition.
The CSHCS Care Coordination unit can assist families and participants find the resources and services they need. The Care Coordinators assess the family’s and participant’s needs and make appropriate referrals to community-based services, medical services, programs (Special Olympics, summer camps, etc.) and gathering financial resources for adaptive equipment (tent-beds, adaptive bikes, house ramps, communication devices, cooling vests, safety rails, etc.). They are also equipped to make referrals outside of service needs. These may include referrals to food pantries, housing, information on support groups, and connections to other family support organizations within Indiana.
Providers and billing companies (third party vendors) can have access to the CSHCS Web Portal. Providers and billing companies must complete the Web Portal Enrollment and Change Request form. If a billing company wants access, the provider must complete a Web Portal form with the information for the billing company they want to have access to their data. The billing company must also complete the web form with their requested login information. When completed return the enrollment form to:
Indiana Department of Health
Attention: OTC/EDI Department
2 N. Meridian Street, 3K
Indianapolis, In 46204
Telephone: 317-233-9803, Fax: 317-233-8199
email: edimail@health.in.gov
The form can be found here
There should be a number on your Electronic Funds Transfer (EFT) that starts with “400C,” which is the designation for our program.
It takes up to two (2) business days for Explanation of Payment (EOP) information to load from the Auditor’s office to the Web Portal.
Please contact the EDI Team at 1-317-233-9803 or 1-800-475-1355 and select option 5, then option 1.
Yes, the provider must complete the Web Portal enrollment as well as their billing company, if only to give permission for the billing company to collect their claims information.
Anyone who can legally sign documents for your office.
Yes, all changes and updates should be made on the Enrollment and Change Request form.
Because of Health Insurance Portability and Accountability Act (HIPAA) regulations, Protected Health Information (PHI) can only be accessed by those with permission to view those files. Each person should have their own login and password based on an individual email.
Please contact the Electronic Data Interchange (EDI) Team at 1-317-233-9803 or 1-800-475-1355 and select option 5, then option 1 and they can verify your email to resend your login information.
The provider’s Web Portal Enrollment should be filled out and signed by the provider giving permission for the billing company to retrieve their claims information using whatever address the provider considers their office. The billing company can then submit their Web Portal Enrollment to access the needed information for that provider.
When trying to submit a claim please make sure the claim type is correct. When trying to submit a claim as a drug claim and it is actually a supply claim, the claim type needs to be changed to reflect that it is a supply claim.
Yes, within one (1) year of the Health Care Services being rendered or the travel occurring. Claims must be submitted upon the appropriate approved paper claim form or using Electronic Data Interchange (EDI) transactions. NO EXCEPTIONS
Insurance updates need to be done: by the Financial Eligibility area. For new Autism diagnosis: Neuropsychological test result or the Developmental Pediatric physician test result is needed. The IEP and/or PHS is not enough proof for CSHCS.
