MedicaidAdministrativeHigh impact
[Indiana] Claims Submission and Matching Logic Reminder
CareSource·IN·Provider Bulletin
Effective date
Jan 1, 2023
We identified it
Aug 7, 2026
Summary
This is a reminder that Indiana Medicaid claims must be submitted with three specific data elements that must match in the state's system: the billing provider's NPI, their taxonomy code, and their billing service location zip code + 4 on file in CoreMMIS. Claims failing to meet this one-to-one matching logic will be rejected or denied, and previously paid claims may be recouped.
Action Required
Immediately: Billing team must verify that all provider records in the practice's billing system contain the following three matching data elements for every Indiana Medicaid claim submission: (1) Billing provider NPI, (2) Billing provider taxonomy code, and (3) Billing provider service location zip code + 4 as currently registered in Indiana's CoreMMIS system. Before submitting claims: Confirm these three elements match what is on file with Indiana Health Coverage Programs (IHCP). Update all provider enrollment records and billing system templates to include the zip code + 4 for service locations. Ensure rendering providers are linked to the billing NPI and service location zip code + 4. Failure to comply will result in claim rejections, denials, and potential recoupment of already-paid claims. Contact Health Partner Services at 1-844-607-2831 (Monday-Friday, 8 a.m. to 8 p.m. EST) for verification of provider matching data in CoreMMIS.