Traditional MedicareCoverageHigh impact
BT202686: IHCP reminds providers of PathWays Dual Care program enrollment, coverage and billing policies
Indiana Medicaid (IHCP)·IN·Claims & Billing
Effective date
Oct 1, 2026
We identified it
Jun 18, 2026
Summary
Indiana launched PathWays Dual Care program integrating Medicare and Medicaid for dually eligible members age 60+, with automatic enrollment into FIDE SNP plans. Effective October 1, 2026, Medicaid will no longer cover Medicare Part D-eligible prescription costs, and providers must verify coverage and bill Medicare as primary for dual-eligible members.
Action Required
Immediately: Update billing workflows to verify PathWays Dual Care enrollment status for all Indiana Medicaid members age 60+ before providing services. Always bill Medicare as primary payer for dual-eligible members. By October 1, 2026: Stop billing Medicaid for prescription costs covered under Medicare Part D for eligible members. Establish internal processes to identify and manage improper billing, including returning payments to IHCP and rebilling Medicare when Medicaid was incorrectly billed as primary.