MedicaidDocumentationHigh impact
BT2024195: IHCP clarifies waiver claim note billing requirement; cautions against using false information
Indiana Medicaid (IHCP)·IN·Claims & Billing
Effective date
Dec 18, 2024
We identified it
Jun 19, 2026
Summary
IHCP requires specific claim note formatting for waiver providers billing Attendant Care and Structured Family Caregiving services, including accurate caregiver name and relationship information. Using incorrect relationship status (like marking a spouse as 'Other') may result in claim recoupment and constitute a false claim under the False Claims Act.
Action Required
By December 18, 2024: Billing team must ensure all Structured Family Caregiving claims through TBI Waiver and MFP programs include properly formatted claim notes with caregiver name and relationship (Parent of minor child, Spouse, or Other). Update billing system to require claim notes in specified format (NAME: [First Last], REL: [Relationship]) for DOS on or after July 1, 2024. Train staff on accurate relationship coding as incorrect entries may result in recoupment and false claims violations.