The Indiana Health Coverage Programs (IHCP) recently released several updates that may impact physicians and their patients: 

FFS provider relations consultants and territories changed Jan. 1
IHCP uses fee-for-service (FFS) provider relations consultants to help providers when they have questions or need assistance. The territories for assigned provider relations consultants changed to seven different regions in Indiana, effective Jan. 1, 2025.

A map showing the changes and contact information for consultants can be found in BT202501 and on the provider relations consultants page at www.in.gov/medicaid/providers. 

OMPP directs PathWays MCEs to waive claims timely filing requirements until Jan. 31
The Indiana Family and Social Services Administration (FSSA) and Office of Medicaid Policy and Planning (OMPP) are directing managed care entities (MCEs) for the Indiana PathWays for Aging (PathWays) program to waive timely filing requirements until Jan. 31, 2025. This affects only claims submitted for PathWays members. 

Any PathWays provider with outstanding claims for submission or resubmission can do so without timely filing requirements causing claim denials. All other claim submission requirements apply.  

Read more in BT2024215.

IHCP updates coverage for physician-administered drugs
IHCP announced coverage updates in BT202502 for physician-administered drug Healthcare Common Procedure Coding System (HCPCS) codes reimbursed through the FFS medical benefit. 

These updates are a result of a recent review of the Medicaid Drug Rebate Program (MDRP) database. Impacted physician-administered drug procedure codes are listed in Table 1 of the BT202502, and coverage updates are effective retroactively for the dates of service (DOS) listed under “special billing information.” Procedure codes impacted are J0391; J2246; J9258; and J9324. 

Read more in BT202502.

IHCP announces updates to pricing and coverage for certain HCPCS codes
IHCP has announced updates to the pricing for certain HCPCS procedure codes. The updated codes are listed in Table 1 of BT2024213, with the individual retroactive effective date indicated for each code. Previously submitted claims for these codes may have been denied in error.

Additionally, IHCP is adding coverage for HCPCS procedure code J2468 – Injection, palonosetron hydrochloride (posfrea), 25 micrograms. This code was previously noncovered by the IHCP, but, effective immediately, the IHCP covers J2468 retroactively for dates of service (DOS) on or after July 1, 2024. Claims for J2468 must include the National Drug Code (NDC). Prior authorization (PA) is not required.

Read more in BT2024213.