[Indiana] Partial Hospitalization Program – Reminders

Immediately: Billing team must implement the following controls in the billing system for Indiana Medicaid PHP claims: (1) Require prior authorization before claims submission for H0035 services; (2) Enforce limit of one H0035 unit per date of service; (3) Prevent billing of inpatient services on the same date as H0035; (4) Flag claims for post-payment review to verify minimum 4-6 hours of active therapy was provided; (5) Validate that services were delivered at least 4 days per week. Front desk and clinical staff must ensure all admission documentation includes individualized treatment plans with measurable, functional, and time-framed goals. Providers must include complete clinical documentation at time of admission for authorization requests. Update encounter forms and EMR templates to prompt for required documentation elements. Billing team should establish internal audit process to identify non-compliant claims before submission. Inform all behavioral health providers of these requirements. Failure to comply will result in claim denials and potential recoupments.