MedicaidReimbursementMedium impact
BT2021108: Changes to reimbursement for eligible out-of-state children’s hospitals
Indiana Medicaid (IHCP)·IN · Pediatrics·Claims & Billing
Effective date
Jul 1, 2021
We identified it
Jun 19, 2026
Summary
Indiana Medicaid will now reimburse eligible out-of-state children's hospitals at 130% of the standard Medicaid rate for inpatient and outpatient services. This affects claims for patients under 19 years old at specific children's hospitals in states bordering Indiana, with mass adjustments being processed for existing claims.
Action Required
By December 29, 2021: Billing team should monitor Remittance Advices for mass adjustments on claims to eligible out-of-state children's hospitals, identified by ICNs beginning with 52 and EOB code 9046. Verify reimbursement increases are properly applied to qualifying inpatient and outpatient claims for patients under 19. Contact Myers and Stauffer LC at INHospital@mslc.com if your facility meets HEA 1305 requirements but hasn't been contacted.