MedicaidAdministrativeMedium impact
BT2024112: IHCP updates guidance on the MCE Emergency Department Autopay List
Indiana Medicaid (IHCP)·IN · Emergency Medicine·Provider Bulletin
Effective date
Jul 1, 2024
We identified it
Jun 19, 2026
Summary
Indiana Medicaid clarified that managed care entities using Emergency Department autopay lists must now review diagnosis codes in all specified claim fields on both UB-04 and CMS-1500 forms, including primary diagnosis, admission diagnosis, patient reason codes, and external cause codes. This expands beyond just primary diagnosis codes to ensure comprehensive emergency service coverage determination.
Action Required
Immediately: Billing team must ensure all emergency department claims submitted to Indiana Medicaid managed care plans include diagnosis codes in all required fields: UB-04 fields 67, 67A-Q, 69, 70A-C, and 72A-C; CMS-1500 field 21A-L. Review current claim submission processes to verify all relevant diagnosis fields are populated, not just primary diagnosis. Contact managed care plans if unsure about their autopay list usage.