Summary
The Indiana Health Coverage Programs (IHCP) found an error in how pricing was set for certain durable medical equipment and medical supply HCPCS codes effective for dates of service on or after January 1, 2024. Those codes were set to pay at the resource-based relative value scale, which resulted in no reimbursement. The error has been corrected in CoreMMIS, and claims that denied for payment will be mass adjusted.
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What to do
Action · 9 steps
01Already effective for dates of service on or after January 1, 2024: For the manually priced codes in Table 1 (A4287, A4457, A6559, A6560, A6561, A6584, A6593 and A6609), the claim must include documentation of the manufacturer's suggested retail price (MSRP), or a cost invoice if no MSRP is available.
02The MSRP or cost invoice must be the most current one and can be no older than two years.
03If no MSRP or cost invoice was included with the original claim for a manually priced code, the billing team must resubmit the claim with the attachment.
04Providers can expect to see adjustments on remittance advices beginning August 21, 2024, with internal control numbers or claim IDs that begin with 52 (mass replacements non-check related) or 80 (reprocessed denied claims).
05For retroactive claims, the bulletin gave 90 days from the July 18, 2024 publication date for managed care claim submission and 180 days for fee-for-service claim submission to satisfy timely filing.
06These windows are historical, so check current applicability before submitting.
07Include the first page of the bulletin when submitting claims beyond the standard filing limit.
08For FFS billing and reimbursement questions, contact Gainwell Technologies at 800-457-4584.
09Claims for managed care members go to the managed care entity the member is enrolled with.
Codes mentioned
A4287A4457A6520A6521A6522A6523A6524A6525A6526A6527A6528A6529A6552A6553A6554A6555A6556A6557A6558A6559A6560A6561A6562A6563A6564A6565A6566A6567A6568A6569A6570A6571A6572A6573A6574A6575A6576A6577A6578A6579A6580A6581A6582A6583A6584A6585A6586A6587A6588A6589A6593A6594A6595A6596A6597A6598A6599A6600A6601A6602A6603A6604A6605A6606A6607A6608A6609A6610
Original notice
BT2024114: IHCP corrects DME pricing
in.gov · Always check the source before changing claims.
Related changes
See all Indiana Medicaid (IHCP) changes →BT2023182: Coverage and billing information for the 2024 annual HCPCS codes updateMediumEffective Jan 1, 2024 · Claims & BillingBT202133: Rates corrected for certain DME codesMediumEffective Feb 1, 2021 · Provider BulletinBT202320: IHCP to update rates for certain DME and medical supply items effective Jan. 1, 2023MediumEffective Jan 1, 2023 · Provider BulletinBT202448: IHCP to update rates for certain DME and medical supply items effective Jan. 1, 2024MediumEffective Jan 1, 2024 · Provider BulletinBrowse every Indiana Medicaid (IHCP) change in the policy list
Related policy hubs
Indiana Medicaid (IHCP) policiesIN policy changesGeneral PracticeCode A4287Code A4457Code A6520Code A6521Code A6522Code A6523Code A6524Code A6525Code A6526Code A6527Code A6528Code A6529Code A6552Code A6553Code A6554Code A6555Code A6556Code A6557Code A6558Code A6559Code A6560Code A6561Code A6562Code A6563Code A6564Code A6565Code A6566Code A6567Code A6568Code A6569Code A6570Code A6571Code A6572Code A6573Code A6574Code A6575Code A6576Code A6577Code A6578Code A6579Code A6580Code A6581Code A6582Code A6583Code A6584Code A6585Code A6586Code A6587Code A6588Code A6589Code A6593Code A6594Code A6595Code A6596Code A6597Code A6598Code A6599Code A6600Code A6601Code A6602Code A6603Code A6604Code A6605Code A6606Code A6607Code A6608Code A6609Code A6610