Traditional MedicareReimbursementMedium impact
BT2025187: IHCP to update FQHC/RHC crossover fee-for-service reimbursement logic
Indiana Medicaid (IHCP)·IN · Family Medicine, Internal Medicine, General Practice +1 more·Claims & Billing
Effective date
Jan 28, 2026
We identified it
Jun 18, 2026
Summary
Starting January 28, 2026, Indiana's Medicaid program will change how it processes Medicare crossover claims for FQHCs and RHCs. These claims will bypass the usual prospective payment system and pay deductibles, coinsurance, and copayments without applying 'lesser of' pricing logic, particularly for QMB-only members.
Action Required
By January 28, 2026: FQHC and RHC billing teams must verify their billing systems are configured to properly submit Medicare crossover claims to Indiana Medicaid. Monitor for additional guidance bulletin from IHCP regarding any required adjustments. Contact Indiana Medicaid Customer Assistance at 800-457-4584 with questions about implementation.