Ind. IHCP Hospice Services Provider Reference Module, Section 5, Timely Submission of Hospice Authorization Paperwork

Hospice providers are required to submit IHCP hospice authorization paperwork to the IHCP FFS PA-UM

contractor within 10 business days of the effective date of the member’s election of hospice services or

within 10 business days of the beginning of the second and subsequent benefit periods. The signatures of the

attending physician, the hospice medical director and hospice interdisciplinary team members must be

completed within the 10 business days for the hospice authorization request to be considered time ly. The

hospice authorization start date will be modified consistent with the late signature dates. Suspending a

request for an additional 30 days does not mean the hospice provider has an additional 30 days to obtain

required signatures and still be considered timely with regard to completion of the physician certification

form and the hospice plan of care.

When there is insufficient information submitted to render a hospice authorization decision, or the

documentation contains errors, a hospice authorization request is suspended for 30 days and the IHCP or its

contractors request additional information from the provider. The provider must make the corrections and

resubmit the proper documentation within 30 calendar days after the additional information or correction is

requested. The provider must either submit an update form, noting the prior authorization number assigned to

the original suspended request, or submit the additional information via the FFS PA-UM provider portal as an

authorization revision to the original request. This process ensures that the subsequent request is not denied as a

duplicate of the original request. If the provider fails to resubmit the documentation with the appropriate

corrections within the 30-day time period, the request for hospice authorization will be denied. The IHCP

contractor must receive the request in the office within the 30th day for the request to be considered

timely. The start date for hospice will be modified for untimeliness for hospice authorization requests for

Medicaid-only and dually eligible hospice members residing in nursing facilities.

If the provider submits additional documentation, within the 30-day time period, but the documentation

submitted does not provide sufficient information to render a decision, the IHCP or its contractors can

request additional information. The provider must submit the additional information within the additional

30 days. If the provider fails to submit the requested information within the additional 30 days, or if

the additional documentation does not provide sufficient information to render a decision, the

request for hospice authorization will be denied.

The hospice provider can appeal the denied hospice authorization.