Ind. IHCP Hospice Services Provider Reference Module, Section 5, Exceptions Related to Untimely Submissions

If a request for hospice authorization or supporting documentation is received after the time limits in this

section, authorization can be granted only for services provided on or after the date that the request is received.

In following four case-specific circumstances, authorization can be granted for services furnished before

the date of a request that does not comply with the time limits in this section:

• Pending or Retroactive Member Eligibility: The hospice authorization must be submitted within

12 months of the date of the issuance of the member’s Hoosier Healthwise card.

• Provider Unaware the Individual was Medicaid-eligible: If the provider was unaware the member

was eligible for services at the time services were rendered, hospice authorization is granted only

under the following circumstances:

➢ The provider’s records document the member refused or was physically unable to provide the

IHCP Member ID.

➢ The provider can substantiate that the provider continually pursued reimbursement from the

patient until IHCP eligibility was discovered.

➢ The provider submitted the request for prior authorization within 60 days of the date IHCP

eligibility was discovered.

• Pending or Retroactive Approval of Nursing Facility Level of Care: The hospice authorization must

be submitted within 12 months of the date nursing facility LOC was approved by the IHCP.

In these three case-specific circumstances, an individual may be retroactively enrolled for IHCP hospice

benefits. Retroactive consideration is given to benefit periods in which CoreMMIS does not reflect a

current nursing facility LOC or member eligibility. Providers must check eligibility on a regular basis and

must check eligibility each hospice benefit period. Subsequent benefit periods are not affected b y eligibility

or level-of-care status of previous benefit periods.

Example: For the first two hospice benefit periods, a hospice member did not have a nursing

facility LOC. The member elected hospice in January 2021. Nursing facility LOC was entered

in the IHCP claim-processing system on May 1, 2021. While the first two benefit periods would

not have been processed due to lack of nursing facility LOC, the third hospice benefit period,

starting in June 2021, should have had a timely submission.