MedicaidReimbursementMedium impact
BT202264: HIP reimbursement policy updated for members requiring admission to LTC facilities
Indiana Medicaid (IHCP)·IN·Claims & Billing
Effective date
Nov 1, 2022
We identified it
Jun 19, 2026
Summary
Indiana's Healthy Indiana Plan (HIP) is updating nursing facility reimbursement to use Medicare rates with a specific adjustment - removing the 3.00 Non-Therapy Ancillary multiplier from the first three days to prevent duplicate pharmacy payments. Providers must use revenue code 0022 with PDPM HIPPS codes and ensure MCEs enter at least '3' prior days in their pricing tools.
Action Required
For HIP members in nursing facilities: Billing team must use revenue code 0022 with appropriate PDPM HIPPS codes on institutional claims (UB-04). Coordinate with MCEs to ensure they enter at least '3' in the prior days field to trigger the adjusted Medicare rate calculation. Verify prior authorization is in place as required by each MCE.