MedicaidPrior AuthMedium impact
BT2025102: IHCP updates the prior authorization and utilization management hierarchy for MCEs
Indiana Medicaid (IHCP)·IN·Prior Authorization
Effective date
Aug 1, 2025
We identified it
Jun 18, 2026
Summary
Starting August 1, 2025, Indiana Medicaid managed care plans (HIP, Hoosier Care Connect, Hoosier Healthwise, and PathWays) must follow a new hierarchy when making prior authorization and medical necessity decisions. MCEs can use InterQual, Milliman Care Guidelines, their own approved criteria, or IHCP policy, but must follow a specific order starting with federal law, then state law, then clinical guidelines.
Action Required
By August 1, 2025: Billing and prior authorization staff should review which Indiana Medicaid MCEs your practice works with and verify their updated medical necessity criteria are posted publicly. Update prior authorization workflows to account for potential changes in approval criteria. Monitor initial denials closely in August-September 2025 as MCEs implement the new hierarchy.