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Indiana Medicaid (IHCP)Medicaid · Documentation · Reimbursement · IN · Emergency Medicine, OB-GYNMedium impact

BT2026185: IHCP updates Emergency Services Only billing requirements

Act
by Nov 30, 2026
Effective date
Nov 30, 2026
Identified
Oct 30, 2026

Summary

Beginning November 30, 2026, the Indiana Health Coverage Programs (IHCP) requires all fee-for-service professional claims for Emergency Services Only (ESO) coverage to include an approved emergency or labor/delivery diagnosis in the primary position AND have the emergency indicator field marked on the claim for each service detail. This affects qualifying non-U.S. citizens enrolled in ESO Coverage with Pregnancy Coverage (Package B) or Emergency Services Only (Package E).

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What to do

by Nov 30, 2026 · 6 steps
01Billing team must implement the following changes for all fee-for-service (FFS) professional claims (CMS-1500 form or electronic equivalent) submitted for IHCP ESO coverage (Package B and Package E).
02Ensure an approved diagnosis code for emergency or labor and delivery services is reported in the primary diagnosis position.
03Mark the emergency indicator field on the claim for each service detail line.
04Update billing software, claim templates, and verification procedures to enforce these requirements.
05Verify that current claim validation logic captures both elements and flag claims missing either element before submission to prevent denials.
06Contact IHCP Customer Assistance at 800-457-4584 with questions or reference the Emergency Services provider reference module at in.gov/medicaid/providers.

Original notice

BT2026185: IHCP updates Emergency Services Only billing requirements
in.gov · Always check the source before changing claims.
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Related policy hubs

Indiana Medicaid (IHCP) policiesIN policy changesEmergency MedicineOB-GYN

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