State · IN
Medical billing services in Indiana
Short answer
Medical billing services in Indiana run on a short clock: a fee-for-service claim must reach the Indiana Health Coverage Programs within 180 calendar days of the service, from discharge for inpatient stays, and since January 29, 2026 each initial paper claim costs a $5 fee.
Four managed care programs run through five managed care entities, Gainwell adjudicates electronic claims within 21 days and paper within 30 before interest starts, telehealth claims deny with EOB 3428 without POS 02 or 10 and modifier 95 or 93, and Verida brokers rides for Traditional Medicaid members. A Remitwright dedicated biller keeps those rules per payer, serving Indiana practices remotely. Rules for other states are on the medical billing services by state page.
Last reviewed by the Remitwright billing team. Editorial policy
Billing in Indiana: what's different
The rules below change how a claim is filed and paid in Indiana. Each line links to the official page it was read from, and the date at the top of this page is when it was last checked.
| Fact | In Indiana | Source |
|---|---|---|
| Medicaid program | Indiana Health Coverage Programs (IHCP)Indiana Family and Social Services Administration (FSSA) | 1 |
| Fee-for-service portal | IHCP Provider Healthcare Portal | 1 |
| How Medicaid is delivered | Mostly managed care | 2 |
| Managed care plans | 5 plansAnthem, CareSource, Humana, Managed Health Services (MHS), UnitedHealthcare | 3 |
| Medicaid timely filing (fee-for-service) | 180 calendar days from the date of service | 4 |
| Prompt-pay law | IC 12-15-21-3(7)(A) for IHCP fee-for-service claims | 4 |
| NEMT | Brokered for fee-for-service members | 6 |
| EVV | Open vendor model | 7 |
Indiana Health Coverage Programs (IHCP)
Indiana Health Coverage Programs (IHCP) is run by the Indiana Family and Social Services Administration (FSSA). Fee-for-service claims and provider enrollment go through the IHCP Provider Healthcare Portal1, at portal.indianamedicaid.com. Mostly managed care: CMS counted 1,609,664 of Indiana's 1,972,638 Medicaid enrollees, 81.6 percent, in full-benefit managed care as of July 1, 20242. The four managed care programs, their enrollment rules and which claims stay fee-for-service with Gainwell are set out in the rules below.
Fee-for-service filing limit: 180 calendar days from the date of service for fee-for-service claims, counted from the date of discharge for inpatient claims4. Crossover claims that Medicare or a Medicare Advantage plan paid, even at zero because of deductible or coinsurance, are exempt; if Medicare denied the service, the 180 days apply. Retroactive member eligibility extends the limit to one year from the date the eligibility was entered in CoreMMIS, and retroactive provider enrollment, a retroactive prior authorization or a late primary payer EOB each restart 180 days from that event, with the proof attached to the claim. A denied claim resubmitted with corrections is treated as a new claim under the same 180 days, and a written request for administrative review is due within 60 days of the remittance advice date. Managed care entities set their own limits in their provider manuals.
Managed care plans3
- AnthemHealthy Indiana Plan, Hoosier Care Connect, Hoosier Healthwise and PathWays
- CareSourceHealthy Indiana Plan and Hoosier Healthwise
- HumanaPathWays for Aging
- Managed Health Services (MHS)Healthy Indiana Plan, Hoosier Care Connect and Hoosier Healthwise
- UnitedHealthcareHoosier Care Connect and PathWays for Aging
Each plan is credentialed separately, has its own portal and its own appeal route. A practice that joins Indiana Medicaid through one plan is not in network with the others until each contract is in place.
Commercial payers and the prompt-pay law
Commercial payers active in Indiana5: Anthem Insurance Companies, Inc., UnitedHealthcare Insurance Company, Humana Insurance Company, Aetna Life Insurance Company, Cigna Health and Life Insurance Company. Each has its own filing window, corrected-claim process and appeal levels in its provider manual, and the timely filing limits table lists verified payer deadlines with their sources.
Prompt pay in Indiana is governed by IC 12-15-21-3(7)(A) for IHCP fee-for-service claims4. Gainwell must adjudicate clean electronic fee-for-service claims within 21 calendar days of receipt and clean paper claims within 30, and a claim adjudicated later than that accrues interest under IC 12-15-21-3(7)(A); claims suspended for medical review and claims from a provider on prepayment review are excluded. Commercial claims follow the payer contract and Indiana's insurance code, and each managed care entity's payment terms sit in its provider manual. In A/R follow-up, a clean claim that sits unpaid is escalated with the statute cited.
NEMT and home care in Indiana
Non-emergency medical transportation. Brokered for fee-for-service members: most nonemergency medical transportation for Traditional Medicaid members is arranged through Verida, and a transportation provider must be enrolled with the IHCP and contracted with Verida to join its statewide network and bill through it6. Advanced life support and basic life support ambulance services are exempt from the brokerage requirement. Rides for Healthy Indiana Plan, Hoosier Care Connect, Hoosier Healthwise and PathWays members are managed through each managed care organization's designated transportation contractor. The NEMT billing in Indiana page covers trip documentation, broker claims and reconciliation.
Electronic visit verification. Open vendor model: Sandata is the state-sponsored EVV system, and a provider that chooses another EVV system must export its visit data to the Sandata Aggregator7. EVV applies to personal care services under select home and community-based services benefit plans for dates of service on or after January 1, 2021, and to home health services on or after January 1, 2024. IHCP bulletin BT2022114 describes recoupment of payments for EVV noncompliance. See home care billing in Indiana for waiver programs, EVV exceptions and authorizations.
Rules that change how Indiana claims are billed
A $5 fee on every initial paper claim since January 29, 20268
IHCP bulletin BT2025181 put a $5 processing fee on each initial fee-for-service paper claim submitted through Gainwell Technologies, collected through an accounts receivable deduction from the provider's future IHCP payments. Five mailed claims cost $25. Corrected or adjusted claims, claims returned to the provider for incorrect submission and claims that require special batch processing are not charged. The fee does not touch claims keyed into the IHCP Provider Healthcare Portal or sent as 837I, 837P or 837D transactions, so a practice still mailing CMS-1500s pays for every one.
Telehealth needs POS 02 or 10 plus modifier 95 or 93, or EOB 3428 denies it9
On a professional or dental claim, every telehealth service carries place of service 02 (outside the patient's home) or 10 (in the home), and the procedure code must be on the IHCP telehealth code set. Medical services add modifier 95 for audio and video or modifier 93 for audio-only, and audio-only pays only for codes the code set marks as allowable that way; dental services need no modifier and cannot be audio-only. A code with modifier 93 or 95 but another POS, a code outside the code set, or an audio-only modifier on a code not approved for it all deny with EOB 3428. Outpatient institutional claims keep the modifier but use no POS code.
Denied claims come back as new claims, disputes go to administrative review in 60 days4
When a denial was the provider's error, the fix is a corrected resubmission, which the IHCP adjudicates as a fresh initial claim inside the 180-day window; a resubmission with no correction is a duplicate and will not count as a continuous attempt to resolve the claim. When the practice disagrees with a denial that was not its error, the route is a written administrative review request filed within 60 days of the remittance advice date. Paid or partially paid claims with a provider error are adjusted or voided and replaced within the same 60 days, and denied claims cannot be adjusted at all.
Fee-for-service claims go to Gainwell, managed care claims go to the entity1
Gainwell Technologies is the IHCP fiscal agent and processes every fee-for-service nonpharmacy claim through the IHCP Provider Healthcare Portal, 837 transactions or mail, while claims for Healthy Indiana Plan, Hoosier Care Connect, Hoosier Healthwise and PathWays members go to the member's managed care entity at the address or portal in that entity's manual. Fee-for-service prior authorization, EVV, pharmacy and transportation brokerage each sit with a different IHCP contractor, so a practice's biller keeps a separate login and routing rule for each one.
Four statewide managed care programs, each with its own plan-change window and short home health limits3
CMS's 2024 state tables list the Healthy Indiana Plan (started February 1, 2015 under 1115(a) authority), Hoosier Care Connect (April 1, 2015, 1915(b)), Hoosier Healthwise (January 1, 2000, 1932(a)) and Indiana PathWays for Aging (July 1, 2024, 1915(b) and 1915(c), with managed long-term services and supports) as statewide programs, with Maximus as the enrollment broker for all four. A member who does not pick a plan is auto-assigned: HIP members have 60 days to change and are locked in once they make a POWER account contribution, Hoosier Healthwise members have 90 days, and PathWays members can change before the effective date, within 90 days of enrolling or annually after that. Home health and nursing facility care inside the plans is short-term, no more than 100 days under HIP Basic and HIP Plus, 30 days under Hoosier Care Connect and 60 days from admission under Hoosier Healthwise, and NEMT is covered only for HIP State Plan and HIP Maternity members, so a home health agency or ride provider checks the member's program before the referral is accepted.
Services for Indiana practices
Remitwright serves Indiana practices remotely, inside the practice management or EHR system the practice already uses. A dedicated biller works the account; nothing is pooled. Each service below explains what that biller does.
- Medical billingClaims worked by one named biller
- CredentialingEnrollment, CAQH and PECOS kept current
- Eligibility verificationCoverage and benefits checked before visits
- Prior authorizationAuths requested, tracked, attached to claims
- Denial managementEvery denial read, worked and appealed
- A/R follow-upUnpaid claims chased before filing limits
FAQ
Questions from Indiana practices
What is the IHCP timely filing limit for Indiana Medicaid claims?
Which managed care entities do we contract with for Indiana Medicaid plans?
How fast does Indiana Medicaid pay a clean fee-for-service claim?
Is there really a fee for mailing paper claims to Indiana Medicaid?
How do we bill an IHCP telehealth visit so it does not deny?
Do our Indiana home health or personal care claims need EVV?
Who arranges a ride for our Traditional Medicaid patients in Indiana?
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