MedicaidPrior AuthHigh impact
BT2022117: Managed care programs will follow the same utilization management hierarchy
Indiana Medicaid (IHCP)·IN·Prior Authorization
Effective date
Apr 1, 2023
We identified it
Jun 19, 2026
Summary
Starting April 1, 2023, all Indiana Medicaid managed care programs (HIP, Hoosier Care Connect, Hoosier Healthwise) must follow a standardized utilization management hierarchy and retire customized guidelines. This creates uniform prior authorization criteria across all Indiana Medicaid plans.
Action Required
By April 1, 2023: Billing team must verify that all Indiana Medicaid managed care prior authorization requests follow the new standardized hierarchy. Update staff training on the specific IHCP policies for ABA therapy, drug testing, hysterectomies, bariatric procedures, transplants, spinal stenosis procedures, oxygen usage, speech-generating devices, EndoPredict breast cancer testing, and ReliZorb. Review current authorization processes to ensure compliance with InterQual or MCG guidelines when IHCP-specific policies don't apply.