Indiana Administrative Code
Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES
Article 10 - HEALTHY INDIANA PLAN
Rule 9 - Providers
Section 9-3 - Provision of covered services; verification of enrollment
Current through September 18, 2024
Authority: IC 12-15-44.5-9
Affected: IC 12-15-44.5
Sec. 3.
(a) Except as provided in subsection (b), before providing any nonemergency service covered under the plan, a provider shall verify all of the following:
Failure to do so may result in denial of the provider's claim if the individual is not enrolled in the plan or the service is not authorized.
(b) Hospitals providing services to individuals during the presumptive eligibility period in accordance with 405 IAC 10-4-11(c), 405 IAC 10-4-11(d), or 405 IAC 10-4-11(e) shall be exempt from the requirements of subsection (a)(1) and (a)(2). Such hospitals shall verify that the individual is eligible for presumptive eligibility under 405 IAC 10-4-11.
(c) If an individual is disenrolled from a managed care organization while receiving inpatient hospital services covered under the plan, the managed care organization shall pay any claims related to the covered inpatient hospital services provided to the member through the date of discharge.
