MedicaidReimbursementMedium impact
BT2022120: Changes made to outlier reimbursement for eligible out-of-state children’s hospitals
Indiana Medicaid (IHCP)·IN · Pediatrics·Claims & Billing
Effective date
Jun 1, 2022
We identified it
Jun 19, 2026
Summary
Indiana Medicaid now reimburses eligible out-of-state children's hospitals at 130% of the calculated Medicaid inpatient hospital outlier payment for patients under 19 years old, effective June 1, 2022. Mass adjustments are being processed retroactively for claims from June through December 2022.
Action Required
Billing team should verify that eligible out-of-state children's hospital claims for Indiana Medicaid patients under 19 are receiving 130% outlier reimbursement. Look for EOB code 9046 on remittance advices to identify enhanced payments. Mass adjustments for FFS claims will appear on RAs beginning February 8, 2023, with ICNs starting with '52'. Contact Myers and Stauffer LC at INHospital@mslc.com if your facility meets HB 1112 requirements but hasn't been contacted.