Ind. IHCP Hospice Services Provider Reference Module, Section 5, Administration Reconsideration and Appeals Process for Hospice Authorization

IHCP members can appeal the denial or modification of hospice authorization under 405 IAC 1.1.

Any provider submitting a request for hospice authorization that was denied, under this rule, can appeal the

decision under 405 IAC 5-7 for administrative consideration of prior authorization decisions.

When insufficient information is submitted to render a decision, or the documentation contains errors, a

hospice authorization is suspended pursuant to 405 IAC 5-34-4 and the IHCP or its contractor requests

additional information from the provider. Suspension is not a final decision on the merits of the request

and cannot be appealed. If the provider does not submit sufficient information within the time frames set

out in 405 IAC 5-34-4(h), the request shall be denied. Denial is a final decision and may be appealed

pursuant to subsections (a) and (b).

See the Prior Authorization Administrative Review and Appeal Procedures section of the Prior Authorization

module for detailed instructions on the PA administrative review and appeals process.