MedicaidAdministrativeHigh impact
BT2021106: IHCP to implement third-party liability cost avoidance on prenatal care claims
Indiana Medicaid (IHCP)·IN · OB-GYN, Family Medicine·Provider Bulletin
Effective date
Dec 31, 2021
We identified it
Jun 19, 2026
Summary
Starting December 31, 2021, Indiana Medicaid (IHCP) will require providers to bill third-party insurance (TPL) before billing Medicaid for prenatal care services. Prenatal care will no longer be exempt from third-party liability cost avoidance requirements.
Action Required
By December 31, 2021: Billing team must update workflows to bill third-party insurance BEFORE billing Indiana Medicaid for all prenatal care services. Update billing system rules to check for TPL coverage on prenatal claims. Train staff that prenatal care diagnosis codes will no longer bypass cost avoidance. Claims billed to IHCP first will be cost avoided if TPL coverage exists.