Indiana Health Coverage Programs (IHCP) implemented the Indiana PathWays for Aging program on July 1, 2024. Claims for members enrolled in PathWays should be submitted to the managed care entity (MCE) with which the member is enrolled. 

IHCP has identified that long-term care (LTC) claims for dates of service (DOS) from July 1 through Sept. 23 may have been paid incorrectly through the fee-for-service (FFS) delivery system.

IHCP has also identified claims for DOS from July 1 through Aug. 22 that may have been denied incorrectly through the FFS delivery system. Members enrolled in the Money Follows the Person (MFP) Aged and Disabled Demonstration Grant may have been denied incorrectly for explanation of benefits (EOB) code 2017 – The member is enrolled in risk-based managed care.

LTC claims paid for DOS from July 1 through Sept. 23 will be recouped on remittance advice (RAs) beginning Nov. 20, with internal control numbers (ICNs)/Claim IDs that begin with 52 (mass replacements non-check related).

Claims for members enrolled in the MFP Aged and Disabled Demonstration Grant and providers that did not have the correct contract assignment will be reprocessed on RAs beginning Nov. 20 with ICNs/Claim IDs that begin with 80 (reprocessed denied claims). 

Providers can submit claims to the IHCP within 90 days from Oct. 17 for managed care claim submission to satisfy timely filing requirements. Providers should include a copy of BT2024168 when submitting claims beyond the standard filing limit.

Read more in BT2024168.