Remote billing, coding, credentialing, and revenue cycle management tuned to Indiana Health Coverage Programs, HIP, and the 2026 managed-care reset so Hoosier practices get paid the first time.
When MDwise exited as a HIP and Hoosier Healthwise plan on January 1, 2026, thousands of Hoosier members were reassigned and every practice that skipped a fresh eligibility check started the year paying for it in denials.
Indiana runs Medicaid through four managed care programs: the Healthy Indiana Plan (HIP) for non-disabled adults 19–64, Hoosier Healthwise for children and pregnant members, Hoosier Care Connect for aged, blind, and disabled members, and Indiana PathWays for Aging for the 60-and-older population. As of 2026, four MCOs carry the volume Anthem Blue Cross Blue Shield of Indiana, CareSource Indiana, Managed Health Services (MHS), and UnitedHealthcare Community Plan with Humana Healthy Horizons added on PathWays. Billing “Indiana Medicaid” really means billing five to six distinct payers under one IHCP umbrella.
HIP adds a wrinkle no other state can copy: the POWER Account. Because HIP members carry a Personal Wellness and Responsibility account tied to their tier (HIP Plus vs. HIP Basic), eligibility, cost-share, and covered benefits vision and dental among them vary by member. Verifying the right HIP tier before the visit is the single most overlooked step in Indiana front-end billing. On the commercial side, Anthem (under Indianapolis-headquartered parent Elevance Health) sets much of the tone, while House Enrolled Act 1004 now pushes the state’s large systems IU Health, Ascension St. Vincent, Community Health Network, Franciscan Health, and Parkview Health into direct-to-employer contracts at or below 260% of Medicare.
These pressures are specific to how Indiana pays not a generic denial checklist you could paste onto any other state.
Reassigned HIP and Hoosier Healthwise members mean stale plan data. Claims routed to the prior MCO reject while your timely-filing clock keeps running.
Indiana pays outpatient behavioral health under 405 IAC 5-20-1 only when a qualifying practitioner certifies the diagnosis. Miss the credential match and the claim denies.
Most behavioral health must be audiovisual. The Q3014 originating-site fee pairs with POS 02 and modifier 95; only a set list is reimbursable audio-only under modifier 93.
With Indiana adding CCBHC encounter codes in mid-2025, clinics that bill under the old logic leave all-inclusive PPS-rate dollars on the table.
IHCP enrollment runs through CoreMMIS under Specialty Matrix Version 11, with risk-based screening. Every delay is a month of services you cannot bill.
ABA therapy, higher-level behavioral services, and many procedures each carry MCO-specific PA rules. One missed authorization can void an entire episode of care.
Every pressure above maps to a specific part of our workflow not a generic feature list.
We confirm eligibility and HIP Plus vs. Basic before each date of service, so claims land at the correct 2026 plan the first time.
Our coders align the rendering credential to Indiana behavioral health policy rather than to generic CPT logic.
Charge review checks Q3014, POS 02, and modifier 95/93 before the claim goes out not after a denial comes back.
We manage IHCP and MCO enrollment, track Matrix Version 11 requirements, and watch revalidation dates so eligibility never lapses.
Standard billing functions, executed with IHCP edits, MCO grids, and Indiana appeal timelines baked in.
Claims scrubbed against each MCO’s timely-filing and PA grid before they ever leave your practice.
Reviewed for Indiana-specific edits and behavioral health documentation standards, not generic code sets.
Verification through posting, reconciling POWER Account cost-shares and direct-to-employer contract terms.
Sequenced so CoreMMIS approval clears before MCO contracting the order Indiana actually requires.
Worked by cause wrong MCO, missing DMHA credential, modifier, or PA gap through the correct Indiana channel.
We remotely support providers throughout Indiana, turning fixed billing overhead into a cost tied to collections.
Indiana’s provider mix runs from urban behavioral health practices to rural clinics in counties HRSA designates as Mental Health Professional Shortage Areas. We tailor edits and appeals to each.
The heaviest documentation load in the state: DMHA certification, supervision rules, ABA prior authorization, and CCBHC encounter logic.
Common where the workforce shortage forces virtual care and where airtight modifier discipline decides whether you get paid.
Juggling HIP tiers alongside Medicare and Anthem commercial lines, each with its own authorization and appeal path.
Including FQHC/RHC encounter and PPS logic, so underserved-county practices capture every reimbursable dollar.
A straightforward workflow that feeds every denial pattern back into front-end checks fewer reworks, faster IHCP and Anthem turnaround.
Confirm the active 2026 MCO and HIP Plus/Basic status up front.
Checked against the correct MCO’s PA grid for the service.
Indiana telehealth and behavioral health modifiers applied at entry.
Claims cleared for both IHCP and commercial edits before submission.
Payments matched to POWER Account and contract terms.
Patterns fed back into eligibility and coding checks.
Send us a recent batch of claims and denials. We’ll map your payer mix against Indiana’s rules and show exactly where collections are slipping.
Request a free claims reviewIf IHCP denials, credentialing delays, or the 2026 MCO shuffle are cutting into collections, we’ll review your claims, payer mix, and denial patterns then show where Indiana-specific fixes pay off.