MedicaidCoverageHigh impact
BT2026129: OMPP changing lookback period for claims with retroactive QMB coverage
Indiana Medicaid (IHCP)·IN·Coverage Policy
Effective date
Sep 1, 2026
We identified it
Jul 31, 2026
Summary
Indiana Medicaid (IHCP) is extending the QMB claim reprocessing lookback period from 24 months to 36 months for members with retroactive Medicare coverage. Effective September 1, 2026, providers must resubmit affected claims with dates of service on or after September 1, 2023. This change applies to both fee-for-service and managed care claims for dually eligible Medicare/Medicaid members.
Action Required
By September 1, 2026: Billing team must identify and resubmit all QMB claims with dates of service on or after September 1, 2023 that were previously denied or unpaid due to the 24-month lookback limitation. Update billing system logic to apply the new 36-month lookback period for retroactive QMB coverage determinations. For managed care claims, contact the member's MCO directly for resubmission instructions and timelines. Verify that all dually eligible members are billed with Medicare as primary payer first; if Medicaid was improperly billed as primary and paid, return payment to IHCP and rebill Medicare. Contact Gainwell Technologies Customer Assistance (800-457-4584) for FFS billing support or your Provider Relations consultant for questions on claim reprocessing procedures.