Ind. IHCP Hospice Services Provider Reference Module, Section 5, Submitting Hospice Authorization Requests

Hospice providers must submit all required forms for Traditional Medicaid (fee-for-service) hospice

authorization to the IHCP fee-for service (FFS) prior authorization and utilization management (PA-UM)

contractor. The preferred and most efficient method for submitting prior authorization requests and

documentation is through the FFS PA-UM provider portal accessible from the Portal Links for Providers

page at in.gov/medicaid/providers. However, providers can also submit PA request forms and

documentation the FFS PA-UM contractor by fax or mail. See the IHCP Quick Reference Guide for contact

information, including telephone and fax numbers and mailing address.

If the member is enrolled in Hoosier Healthwise, the FFS PA-UM contractor can coordinate with the

managed care enrollment broker to disenroll the member from managed care. To initiate this process, the

hospice provider can fax the Medicaid Hospice Election form to the FFS PA-UM contractor’s dedicated

fax line for disenrolling hospice patients from Hoosier Healthwise: 800-922-9805. Providers must follow

up the fax with a telephone call to 866-725-9991, notifying the FFS PA-UM staff that a fax has been sent

for disenrollment of a hospice member from managed care. See the Hospice Services for Hoosier

Healthwise Members section for instructions on how to initiate the disenrollment process. Hospice

authorization starts the date after the member is disenrolled from managed care.

Note: For Healthy Indiana Plan (HIP), Hoosier Care Connect and Indiana PathWays

for Aging (PathWays) members, hospice authorization requests and related

documentation should be submitted to the appropriate managed care entity (MCE)

or its designated PA-UM contractor. See the IHCP Quick Reference Guide for

contact information.