MedicaidAdministrativeMedium impact
BT202009: IHCP changes requirements for MCE emergency services claim processing
Indiana Medicaid (IHCP)·IN · Emergency Medicine·Claims & Billing
Effective date
Apr 1, 2020
We identified it
Jun 19, 2026
Summary
Indiana Medicaid managed care entities (MCEs) must now use the state's Emergency Department Autopay List when determining emergency services claims, and providers can submit medical records for prudent layperson review within 120 days if claims are paid at screening fees.
Action Required
By April 1, 2020: Billing team must review the Emergency Department Autopay List at in.gov/medicaid/providers before submitting ED claims. For claims not matching the autopay list, submit medical records with initial claim to avoid screening fee payment. If paid at screening fee, submit records for prudent layperson review within 120 days to receive full reimbursement.