As part of a collaborative workflow improvement project with stakeholders, the Indiana Health Coverage Programs (IHCP) is issuing a clarification to IHCP Banner Page BR201839. Members determined as retroactively eligible under Hoosier Healthwise aid categories do not receive a managed care assignment for the retroactive eligibility period.
Instead, during the retroactive period, member benefits are covered through the fee-for-service (FFS) delivery system.
However, the exception to this policy is for newborns whose mothers were enrolled with a managed care assignment on
the date of the child’s birth. In this case, the baby is assigned to the mother’s managed care entity (MCE), retroactively
effective to the date of birth. The mother’s and the baby’s coverage remains with the MCE during the baby’s retroactive
Once a Member ID is assigned to the baby, providers may send claims for the baby’s care to the mother’s MCE. Prior
authorization (PA) for services may be required.
Providers should check with the MCE about PA before submitting
claims, or retroactive PA requests.
For more information about Hoosier Healthwise, see the Member Eligibility and Benefit Coverage provider reference
module at in.gov/medicaid/providers.