MedicaidReimbursementHigh impact
BT2026135: IHCP clarifies laboratory services reimbursement
Indiana Medicaid (IHCP)·IN·Provider Bulletin
Effective date
Jan 1, 2024
We identified it
Aug 14, 2026
Summary
Indiana Health Coverage Programs (IHCP) clarifies that laboratory services have been reimbursed at 100% of prior year Medicare rates since January 1, 2024, not at 60% as the outdated fee schedule label suggested. Managed care organizations (MCOs) must reprocess all laboratory claims from January 1, 2024 forward to pay at the correct 100% rate. The fee schedule rate type has been renamed from 'Lab 60 Percent' to 'Lab' to prevent future confusion.
Action Required
Immediately: Billing team must identify and coordinate with all MCO partners to ensure laboratory claims from January 1, 2024 to present are reprocessed to reimburse at 100% of fee schedule instead of 60%. Contact each MCO's billing department to verify reprocessing status and timeline. Update internal documentation and fee schedule references to reflect the corrected 'Lab' rate type (no longer 'Lab 60 Percent'). For fee-for-service claims, no action is needed as they were billed correctly. Document all reprocessing requests and follow up with MCOs within 30 days to confirm completion. Contact Gainwell Technologies Customer Assistance at 800-457-4584 if MCOs do not cooperate or if questions arise about which claims require reprocessing.