MedicaidAdministrativeHigh impact
[Indiana] Out of Network Claims Filing Limit
CareSource·IN·Network
Effective date
Jan 1, 2026
We identified it
Jul 22, 2026
Summary
CareSource Indiana Medicaid has reduced the out-of-network claims filing deadline from 180 calendar days to 90 calendar days from date of service or discharge, effective January 1, 2026. Claims filed after 90 days will be denied for timely filing, except when eligibility is updated. This change aligns with federal Medicaid regulations (42 CFR 447.45(d)(4)).
Action Required
By December 31, 2025: Billing team must implement process changes to track and enforce the 90-calendar-day filing deadline for all out-of-network CareSource Indiana Medicaid claims. (1) Update billing system to flag or automatically deny claims exceeding 90 days from service/discharge date. (2) Establish claim submission tracking procedures to ensure out-of-network claims are submitted within 90 days. (3) Brief all billing staff on the new deadline and implement monitoring to catch claims at risk of late filing. (4) For out-of-network providers, communicate the new deadline and ensure they understand the consequences of delayed submission. (5) Review existing aging claims and prioritize submission of any out-of-network Indiana Medicaid claims within 90 days if not yet filed. Failure to file within 90 days will result in automatic claim denials, with no exceptions except when member eligibility is updated retroactively.