Best practices for nonpharmacy claims

The Indiana Health Coverage Programs (IHCP) offers these tips for making claims processing go as smoothly as possible.

Submit claims electronically!

Electronic claims process in one-third the time required for paper claims. Electronic submissions also reduce errors, prevent unnecessary claim denials, increase cash flow, and decrease costs. Electronic claims processing is:

  • Faster - Most electronically submitted claims process in one to two weeks, compared to paper claims, which typically process in 30 days. If you use the IHCP Provider Healthcare Portal to submit your claims, they are adjudicated immediately. Electronic submissions are automatically read by system edits. When a clean claim is submitted by close of day Wednesday, you can look for final processing by Tuesday of the following week.
  • Easier - You can easily submit all fee-for-service claims, including claims requiring attachments, using the Provider Healthcare Portal. The Portal also allows easy resubmission of claims.
  • More accurate - Electronic claims help reduce keying errors. In addition, claims submitted on paper are often handwritten, which makes them less clear and harder to read. Electronic submission eliminates these problems.
  • Less expensive - With electronic claim submission, provider staff members no longer spend time printing and mailing forms - a costly process.

Electronic submission is the easiest, most accurate, and least expensive way to submit claims. For more information about submitting electronic claims through the Provider Healthcare Portal, see:

Follow these general tips

  • Include valid IHCP Member IDs (RIDs) with all claim types.
  • Be sure to include a valid National Provider Identifier (NPI) with all claim types (except waiver and atypical providers). Also check that the NPI submitted with your claims is correct - that you have not transposed or omitted numbers, or made other errors - and that it is registered with the IHCP.
  • DO NOT use red ink - it disappears when claims are scanned.
  • Be sure Medicare, third-party liability (TPL), and Medicaid information is placed in the proper fields on institutional (UB-04) claims:
    • A = Medicare - 54a
    • B = Third-Party Liability, including Medicare Replacement Plans - 54b
    • C = Medicaid - 55c
  • Submit proper invoices for manual pricing on non-check adjustments.
  • When you submit adjustment forms with check-related adjustments, be sure to submit all required information - claim numbers or internal control numbers (ICNs), Member IDs, dates of service (DOS), and procedure codes. The more information you include, the more quickly the IHCP can process the adjustment.
  • Make sure hand-written paper claims are legible, and those that require signatures include full signatures and NOT JUST initials.

Use claim notes appropriately

Remember - if you submit claim notes with 837 transactions or via the Portal, the IHCP does not accept all types of claim notes as documentation. For details about when to submit claim notes to the IHCP, see the Claim Submission and Processing provider reference module.

Guidelines for DME cost invoices

The IHCP requires invoices for Healthcare Common Procedure Coding System (HCPCS) codes for durable medical equipment (DME), supplies, and hearing aids that are not manually priced. The following are considered acceptable documentation of the manufacturer's suggested retail price (MSRP):

  • Manufacturer's invoice showing MSRP, suggested retail price, or retail price
  • Quote from the manufacturer showing the MSRP, suggested retail price, or retail price
  • Manufacturer's catalog page showing MSRP, suggested retail price, or retail price (the publication date of the catalog must clearly show on the documentation)
  • MSRP pricing from the manufacturer's website (the manufacturer's web address must be visible on printed documentation from its website)

For more information, see the Durable and Home Medical Equipment and Supplies provider reference module.

Learn more about claim submission

For more detailed information about submitting claims, see the Claim Submission and Processing and the Provider Healthcare Portal provider reference modules.