MedicaidAdministrativeMedium impact
[Indiana] Substance Use Disorders Best Practices
CareSource·IN · Psychiatry·Provider Bulletin
Effective date
Feb 1, 2025
We identified it
May 9, 2026
Summary
CareSource Indiana has issued best practice reminders for Substance Use Disorder (SUD) inpatient and residential treatment benefits under Hoosier Healthwise (HHW) and Healthy Indiana Plan (HIP). Key requirements include: submitting prior authorizations on the specific Indiana Health Coverage Programs form with only one assignment category selected, faxing discharge summaries to a designated number for care coordination, requiring in-person initial evaluations within seven days followed by weekly evaluations (with telemedicine follow-up permitted), and using the Provider Portal for Care Management referrals.
Action Required
Immediately: (1) Billing and prior authorization team must update internal processes to ensure all SUD inpatient and residential prior authorizations are submitted using ONLY the Indiana Health Coverage Programs Prior Authorization Request Form (available at https://www.in.gov/medicaid/providers/provider-references/forms/); (2) Train billing staff to select EITHER 'Inpatient' OR 'Residential' on the assignment category field—never both—to prevent claim denials; (3) Update discharge procedures to require clinical staff to fax all discharge summaries for both inpatient and SUD residential patients to fax number 937-487-1664 within 24 hours of discharge; (4) Update provider portal training materials to direct clinical staff to submit Care Management referrals through the Indiana Provider Portal (Providers > Care Management Referral) or by phone (1-844-607-2829); (5) Ensure clinical documentation templates reflect the requirement that initial SUD residential evaluations must be completed in-person within seven calendar days and follow-up evaluations must occur at least every seven days (conducted by physician, PA, or APRN, with telemedicine permitted for follow-ups only). Failure to obtain prior authorization or submit discharge summaries will result in claim denials and coordination-of-care delays.