MedicaidPrior AuthMedium impact
Indiana Medicaid: New prior authorization requirements for additional incontinence products
UnitedHealthcare·IN · Family Medicine, Internal Medicine, Geriatrics +1 more·State news
Effective date
Jan 1, 2026
We identified it
Jan 12, 2026
Summary
Starting January 1, 2026, UnitedHealthcare will require prior authorization for most incontinence products when the service exceeds the monthly monetary benefit limit for Indiana Medicaid members (Community Plan, PathWays for Aging, and Hoosier Care Connect plans). Prior auth requests must include nursing assessments and clinical documentation supporting medical necessity.
Action Required
By January 1, 2026: Billing team must update prior authorization workflows for incontinence product claims exceeding monthly benefit limits for Indiana Medicaid members. Ensure nursing assessments are completed by licensed nurses employed by the supplying provider and clinical documentation supporting medical necessity is gathered before submitting requests. Use universal provider authorization fax form and fax requests to 844-897-6514. Claims exceeding benefit limits without prior authorization will be denied.