Find information here about conducting business transactions with the Indiana Health Coverage Programs (IHCP), including member eligibility, billing, reimbursement and recordkeeping:
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Partner Reference
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Bulletins, Banner Pages and Reference Modules
Bulletins, Banner Pages and Reference Modules
Use the links on this page to access IHCP provider news items, bulletins, and banner page publications.
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Email Notifications
Email Notifications
The email notifications are used to send notices to subscribers on behalf of the IHCP. To receive notices, you must subscribe.
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Forms
Forms
Find the forms you need to serve members and transact business with the IHCP.
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Other Resources
Other Resources
For information about IHCP policies, procedures, and billing guidance (including information about electronic transactions), access these IHCP reference documents.
Programs and Authority
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IHCP Programs
IHCP Programs
Find information about the healthcare programs included under the Indiana Health Coverage Programs (IHCP) umbrella – the primary programs serving most children and adults as well as those designed to serve special member populations.
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Indiana Medicaid State Plan
Indiana Medicaid State Plan
View the Indiana Medicaid State Plan – an agreement between the state and federal government describing how Indiana administers its Medicaid program.
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Procurement Opportunities
Procurement Opportunities
Solicitation opportunities to do business with the state of Indiana
Medicaid Partners
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Acentra Health
Acentra Health
Acentra Health is the fee-for-service (FFS) prior authorization and utilization management (PA-UM) contractor for the IHCP.
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Gainwell Technologies
Gainwell Technologies
Gainwell Technologies has been contracted with the state of Indiana since 1991. Gainwell provides a number services to the IHCP, including provider enrollment, customer service, eligibility verification, and fee-for-service claim processing.
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Maximus
Maximus
MAXIMUS Health Services Inc. has served as the Indiana Health Coverage Programs enrollment broker since 2007.
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Optum Rx
Optum Rx
The Indiana Health Coverage Programs contracts with Optum Rx to be the pharmacy benefits manager for Traditional Medicaid and other fee-for-service benefits.
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Verida
Verida
Verida, Inc. is the nonemergency medical transportation broker for Indiana Traditional Medicaid (fee-for-service) members who require assistance traveling to their covered healthcare services.
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Incontinence Providers
Incontinence Providers
The Indiana Health Coverage Programs contract with two durable medical equipment suppliers to provide incontinence, ostomy and urological supplies, including diapers, under- pads, ostomy bags and gloves to members enrolled in Traditional Medicaid.
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Dual Eligible Special Needs Plans
Dual Eligible Special Needs Plans
Dual Eligible Special Needs Plans serve members who are eligible for both Medicaid and Medicare. D-SNP health plans offer care coordination and provide supplemental benefits to their beneficiaries.
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Managed Care Health Plans
Managed Care Health Plans
Indiana Health Coverage Programs works with four health plans to serve as managed care entities for the Hoosier Healthwise, Hoosier Care Connect, Healthy Indiana Plan and Indiana PathWays for Aging programs.
Business Transactions
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EDI Solutions
EDI Solutions
Important information to all providers and software developers that communicate via electronic data interchange (EDI) format and direct data entry (DDE).
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IHCP Companion Guides
IHCP Companion Guides
This page contains Indiana Health Coverage Programs (IHCP) Companion Guides for Health Insurance Portability and Accountability Act (HIPAA) version 5010 electronic transactions.
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Program Integrity
Program Integrity
The mission of the Office of Medicaid Policy and Planning (OMPP) Program Integrity Unit is to guard against fraud, abuse, and waste of Medicaid program benefits and resources.
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HIPAA
HIPAA
The Health Insurance Portability and Accountability Act (HIPAA) of 1996 contains Portability, Medicaid Integrity Program/Fraud and Abuse, and Administrative Simplification.
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Electronic Visit Verification
Electronic Visit Verification
The IHCP will implement an electronic visit verification (EVV) system for federally required provider documentation of designated personal care and home health services.
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IHCP Fee Schedules
IHCP Fee Schedules