MedicaidPrior AuthMedium impact
BT2025166: Nursing facility LOC must be entered in CoreMMIS before hospice providers submit a PA request
Indiana Medicaid (IHCP)·IN · Palliative Care·Specialty Services
Effective date
Jan 1, 2026
We identified it
Jun 18, 2026
Summary
Starting January 1, 2026, hospice providers must ensure nursing facility level of care (LOC) is entered in CoreMMIS before submitting prior authorization requests for fee-for-service members in nursing facilities. If LOC is not on file, the PA request will be rejected and must be resubmitted after the LOC is updated.
Action Required
By January 1, 2026: Hospice billing teams must verify that nursing facility level of care (LOC) is entered in CoreMMIS before submitting any prior authorization requests in the Atrezzo Provider Portal for FFS members residing in nursing facilities. Update workflow to check LOC status first, then coordinate with Gainwell to enter LOC if missing before PA submission. Failure to verify LOC will result in PA rejection and require resubmission.