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

Fee-for-service claims denied incorrectly Oct. 8-31
IHCP has identified a system issue that may have incorrectly denied claims submitted and processed from Oct. 8 through Oct. 31.

This issue impacted a variety of provider types, services and claim types. The claim-processing system has been corrected, and newly submitted claims are processed correctly.

Claims submitted and processed Oct. 8 through Oct. 31 that were denied in error have been reprocessed. Providers should see reprocessed claims on remittance advices (RAs) beginning immediately with internal control numbers (ICNs)/Claim IDs that start with 80 (reprocessed denied claims).

Read more in BT2024184.

Coverage of additional biomarker testing codes
Per Senate Enrolled Act 273, beginning July 1, 2024, IHCP expanded coverage for biomarker testing when certain conditions are met. In IHCP Bulletin BT2024126, IHCP published an updated biomarker testing policy and a list of biomarker testing CPT codes that meet criteria for coverage. 

IHCP has identified additional biomarker testing codes that meet the criteria. Codes listed in the table in BT2024185 are covered by IHCP retroactively for dates of service (DOS) on or after Nov. 1, 2024.

Read BT2024185 for more information.

IHCP revises coverage and PA requirements for physician-administered drugs
IHCP recently announced coverage and prior authorization (PA) changes for select physician-administered drugs reimbursed through the medical benefit. These updates are a result of a recent review of the Medicaid Drug Rebate Program (MDRP) database. Impacted Healthcare Common Procedure Coding System (HCPCS) codes are listed in Tables 1 and 2. 

Table 1 lists newly covered physician-administered drug codes. The IHCP is adding coverage for these codes effective immediately, retroactive to DOS on or after the dates listed in the special billing information column. Additionally, for DOS on or after Nov. 21, coverage of these drugs requires prior authorization (PA).

For more information, read BT2024186.