When does this change take effect?

This change is effective Nov 1, 2024.

MedicaidAdministrativeHigh impact

BT2024162: Claims for school-based services will deny without ordering or referring provider’s NPI

Q: Who is affected by this change?

This affects Indiana Medicaid (IHCP) Pediatrics, Physical Therapy, Occupational Therapy providers in IN on Medicaid plans.

Indiana Medicaid (IHCP)·IN · Pediatrics, Physical Therapy, Occupational Therapy·Enrollment

Effective date

Nov 1, 2024

We identified it

Jun 19, 2026

Days to comply

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Summary

Starting November 1, 2024, Indiana Medicaid will deny all claims for school-based services and First Steps program services that do not include the ordering or referring provider's NPI number. Claims missing this information will be denied with EOB code 1132.

Action Required

Action needed

By November 1, 2024: Billing team must update all claim submission processes for school-based services (provider type 12, specialty 120) and First Steps program claims to require ordering or referring provider NPI numbers. Update billing software validation rules to prevent submission without NPI. Train staff to verify NPI is included before claim submission. Claims without ordering/referring provider NPI will be denied with EOB code 1132.

Related policy hubs

Indiana Medicaid (IHCP) policies IN policy changes Pediatrics Physical Therapy Occupational Therapy